OBJECTIVES: We assessed characteristics associated with pediatric COVID-19 hospitalizations and risk factors for severe disease among hospitalized children ≥6 months. METHODS: Using data from COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) during October 1, 2022-April 30, 2024, we described demographic characteristics, underlying medical conditions, COVID-19 vaccination status, and clinical outcomes, including severe disease (ICU admission, mechanical ventilation, extracorporeal membrane oxygenation, in-hospital death), of hospitalized children 6 months-17 years residing in the COVID-NET catchment area with laboratory-confirmed SARS-CoV-2 infection. Multivariable log-linked Poisson generalized estimating equations were conducted to assess risk factors for severe disease among children 6-23 months and 2-17 years. RESULTS: Of 2,490 children hospitalized for COVID-19, 1114 (44.7%) were 6-23 months; 1358 (54.1%) were male. Overall, 1464 (58.9%) had ≥1 underlying conditions: 471 (41.8%) of children 6-23 months, 290 (61.6%) 2-4 years, 383 (79.2%) 5-11 years, and 320 (77.0%) 12-17 years. 100 (3.8%) were up-to-date with recommended COVID-19 vaccination. Among children 6-23 months, severe disease was associated with underlying chronic lung (adjusted risk ratio [aRR] 1.5, 95% CI: 1.2-1.8) and cardiovascular disease (aRR: 1.4, 95% CI: 1.1-1.7). Among children ≥2 years, severity was associated with chronic lung disease (aRR: 1.9, 95% CI: 1.5-2.3), diabetes (aRR: 1.5, 95% CI: 1.2-1.8), and neurologic disorders (aRR: 1.4, 95% CI: 1.2-1.6). CONCLUSION: Most hospitalized children ≥6 months had ≥1 underlying conditions and <5% were up-to-date with COVID-19 vaccination. Specific conditions were associated with increased risk of severe illness. Increasing COVID-19 vaccination, particularly among children with high-risk conditions, may reduce pediatric COVID-19 hospitalizations and severe outcomes.

The 38(th) International Conference on Antiviral Research (ICAR), sponsored by the International Society for Antiviral Research (ISAR), took place March 17-21, 2025 in Las Vegas, Nevada, USA. The annual meeting brought together leading scientists from across academia, industry, and government to present the latest advances in antiviral research. Topics included discovery and development of novel antiviral agents, innovative therapeutic approaches, vaccine technologies, host-targeted strategies, and responses to emerging and re-emerging viral threats. ICAR 2025 featured keynote talks, short oral presentations, poster sessions and special sessions to encourage discussions between attendees and foster interdisciplinary collaboration. Several events were held to support the next generation of antiviral researchers, including dedicated sessions and networking opportunities focused on mentorship and career development for students, postdoctoral fellows, and early-career scientists. Importantly, ISAR continues to serve as a cornerstone for international collaboration and innovation in antiviral science, and the society is eager to continue these efforts at the 39th ICAR, to be held in Prague, Czech Republic, from April 27-May 1, 2026.

BACKGROUND: Viral load suppression among people living with HIV is a key strategy for reducing HIV transmission. A global target for HIV elimination aims to have 95% of people living with HIV diagnosed, 95% of people diagnosed on antiretroviral therapy (ART), and 95% viral load suppression for those on ART. We aimed to assess viral load non-suppression rates and associated factors among people living with HIV on ART in the Sughd region of Tajikistan. METHODS: We conducted a retrospective cohort study of adults (≥ 18 years old) who were newly diagnosed with HIV in 2013–2022 and had received ART for ≥ 6 months in the Sughd Region. Data were collected from the national electronic HIV case surveillance system and cross-referenced with paper medical and laboratory records. We conducted multivariable Quasi-Poisson regression to identify factors associated with viral load non-suppression (defined as ≥ 1000 copies/mL on their latest viral load test). RESULTS: Among the 1,871 people newly diagnosed with HIV who received ART for ≥ 6 months from 2013 to 2022, 11% were not virally suppressed. Over half (57%) were male, 38% were migrants, 73% were married, and the median age was 31 years (range 18–74). One-third (32%) had advanced HIV disease at diagnosis, 58% had been on ART for < 5 years, 94% were on a dolutegravir-containing regimen (DTG), and 9% died. Viral load non-suppression was 23% among people with stage IV at diagnosis and 43% among those not on DTG. Higher risk of viral load non-suppression was observed among male migrants and male nonmigrants compared to female nonmigrants (adjusted relative risk [aRR] and 95% confidence interval = 1.61 [1.13–2.31] and aRR = 1.48 [1.03–2.14], respectively), those who never-married vs. married (aRR = 1.56 [1.05–2.25]), those on ART for < 5 years vs. longer (aRR = 1.56 [1.05–2.29]), those initiating ART in 2013–2018 compared to 2019–2020 (aRR = 1.92 [1.28–2.88]), and those not on DTG (aRR = 3.86 [2.63–5.69]). CONCLUSIONS: Viral load suppression among people living with HIV in the Sughd Region remains below the global 95% target. Viral load suppression may improve with increased treatment support for people with late diagnosis or those newly initiating ART, with a special focus on men and migrants.

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV infection in the United States, especially Black MSM (BMSM) and Hispanic/Latino MSM (HLMSM). Long-acting preexposure prophylaxis (LA PrEP) is effective in preventing HIV; however, medical mistrust may contribute to barriers in uptake among BMSM and HLMSM. We assessed the role of medical mistrust in BMSM and HLMSM's unwillingness to use LA PrEP. BMSM and HLMSM aged ≥18 years without a previous HIV diagnosis or current PrEP use were recruited through dating and general interest websites/apps. Using Poisson regression with robust standard errors, we conducted multivariate analyses to assess the association between medical mistrust and willingness to use LA PrEP (i.e., injection or rod implanted in the arm) separately for each racial/ethnic group. Over 90% of the 1,126 BMSM and 924 HLMSM in this study were willing to use some form of PrEP; however, only 74% of BMSM and 81% of HLMSM were willing to use PrEP injections, and significantly fewer BMSM (30%) were willing to receive a PrEP implant compared with 44% of HLMSM. After controlling for sociodemographic, behavioral, and clinical covariates, medical mistrust was associated with lower willingness to use LA PrEP for BMSM, but not for HLMSM. Addressing and reducing medical mistrust among BMSM is important to increase the use of LA PrEP as an effective HIV prevention strategy. Addressing structural barriers and building trust within healthcare systems are crucial steps in reducing disparities in HIV infection among BMSM and HLMSM.

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are persistent organic pollutants, many of which exhibit low in vivo clearance rates. The long-chain PFAS (≥6 perfluorinated carbons), due to low clearance rates, are often perceived to exert a higher toll on human health than short-chain PFAS. However, a comprehensive toxicological and epidemiological comparison of long- and short-chain PFAS is overdue, leaving significant data gaps and limitations. For the first time, this study investigated the quantitative relationship between overall PFAS fluorine structure (C-F bond), which includes the alkyl chain length as one component, and PFAS doses that trigger changes in rat blood-based clinical markers. Fifteen markers published by the National Toxicology Program (NTP) after 28-day exposure to 7 PFAS with both long- and short-chain perfluorinated alkyl structures were examined. The aim of this study was to (1) determine PFAS doses that trigger changes in the marker levels for hepatic, renal, cardiovascular, and metabolic systems and (2) use these doses in multiple linear regression models to examine relationship to variables describing PFAS chemical structures. Our findings showed a log-linear dependence of alterations in marker levels on PFAS fluorine structure, as measured in the number of alkyl carbon-fluorine (C-F) bonds. Each C-F bond affected the marker effect levels by 0.45 ± 0.01 mmol/kg-day. The variety of studied clinical markers suggests that PFAS exposures led to deviations in multiple biological pathways in the rat animal model, which may inform future research and regulatory decisions. | Perfluorinated carboxylic or sulfonic acids with linear chains of 4 to 10 carbons, known as perfluoroalkyl acids (PFAA)s, are types of PFAS commonly found in the environment.In a 28-day study by NTP, these PFAAs had dose-response effects in a panel of blood-based clinical markers in rats at specific doses.In regression models for individual clinical markers or a joint regression for all markers, these doses were strongly correlated with the number of carbon-fluorine bonds in the PFAAs.The resulting multiple linear regression (MLR) models provide a simple estimation tool for PFAAs’ exposure levels on blood-based clinical marker responses in rats. | eng

BACKGROUND: School health education promotes health knowledge and skills, yet measurement of teens' health skills is limited. We psychometrically assessed the perceptions of skills enhanced through school health education (PSE-SHE) measure. METHODS: Cross-sectional data (n = 471) were collected from teens using Teen and Parent Surveys of Health, conducted through AmeriSpeak Panels. The survey included one 5-item question assessing teens' perceptions of health skills enhanced through school health education-including getting health information and services, and understanding factors influencing health, communication, decision-making, and advocacy. For each PSE-SHE item, a 3-level categorization measure was examined (strongly agree/agree, neither agree nor disagree, and strongly disagree/disagree). Cronbach's alphas and confirmatory factor analysis (CFA) examined PSE-SHE measures' reliability and validity. Structural equation modeling used the CALIS procedure (SAS 9.4). RESULTS: High Cronbach's α = 0.91 was observed for the PSE-SHE measure, indicating internal consistency. Polychoric correlations among PSE-SHE items (0.68-0.81) were found. CFA confirmed substantial factor loadings (0.72-0.84, p < 0.0001) of each item on the latent factor (CFI = 0.98), supporting construct validity. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The reliable and valid PSE-SHE measure may inform skills-focused health education research. CONCLUSIONS: Psychometric results confirm the PSE-SHE measure is valid in capturing perceptions of skills enhanced through school health education.

Objective: To compare clinical and socioeconomic characteristics of U.S. Medicare beneficiaries overall and with diagnosed diabetes by age group (18–64 years and ≥65 years) and insurance type (traditional fee-for-service [FFS] vs Medicare Advantage [MA]) and to compare the prevalence of diabetes among beneficiaries by age group and type of insurance. Methods: In this retrospective, cross-sectional study from the U.S. Medicare Current Beneficiary Survey (MCBS), we combined data from 2017 to 2022 and conducted an unadjusted, pooled analysis of administrative and survey data, weighted to represent U.S. Medicare beneficiaries. We used logistic regression to assess difference by insurance type in care satisfaction. Results: Beneficiaries more likely to enroll in MA than FFS were the same groups at high risk of diabetes, including non-Hispanic Black (18–64: 21.2 % vs 15.9 %; ≥65: 11.4 % vs 6.5 %) and Hispanic (18–64: 14.4 % vs 8.9 %; ≥65: 11.0 % vs 5.4 %) populations, those with less than a high school education (≥65: 16.4 % vs 9.2 %) or annual income <$25,000 (18–64: 69.0 % vs 64.0 %; ≥65: 34.5 % vs 21.6 %), and full dual-eligible beneficiaries (≥65: 10.5 % vs 6.1 %). Beneficiaries with diabetes enrolled in MA did not differ from those enrolled in FFS in diabetes self-management or satisfaction with healthcare. Conclusions: Subgroups of people at highest risk of diabetes were more likely to enroll in MA. Our findings support studies reporting that people with diabetes self-select into MA, and their lack of difference in satisfaction between FFS and MA may support studies that report MA is no less effective than FFS in diabetes care. © 2025 The Authors

BACKGROUND: Nucleic acid-based assays are the diagnostic gold standard for filoviruses, including Ebola (EBOV) and Sudan (SUDV) viruses. However, outbreaks in areas with limited laboratory infrastructure highlight the need for simpler diagnostic tests that can be rapidly and safely used in the field. METHODS: We evaluated eight antigen rapid diagnostic tests (Ag-RDTs) for their ability to detect EBOV and SUDV. Analytical panels using virus cell slurries were used to assess limit of detection, and clinical samples were tested to determine sensitivity and specificity. RESULTS: Five Ag-RDTs detected EBOV and three detected SUDV, although clinical sensitivity was low (20-40 % for EBOV, 33 % for SUDV), improving only with higher viral loads. All assays demonstrated 100 % clinical specificity with no cross-reactivity. DISCUSSION: Although none of the evaluated Ag-RDTs are suitable for routine diagnosis, some may be useful in high viral load contexts such as cadaver testing. Our findings highlight the need to improve Ag-RDT sensitivity or develop high-sensitivity point-of-care molecular diagnostics.

Chi-square tests are often employed to examine the association of categorical variables, the homogeneity of proportions between two or more samples, and the goodness-of-fit for a specified distribution. To account for the complex design of survey data, variants of Chi-square tests as well as software packages that implement these tests have been developed. Nevertheless, from a survey practitioner’s perspective, there is a lack of applied literature that reviews and compares alternative options of survey Chi-square tests and their associated programming and output. This article aims to fill such a gap. Many modern statistical software packages for survey analysis are capable of computing either the Wald Chi-square test or the Rao-Scott Chi-square test, along with other types of Chi-square tests, including the Rao-Scott likelihood ratio Chi-square test and the Wald log-linear Chi-square test. This article focuses on these four types of Chi-square tests, and examines four statistical packages that compute them in SAS®, R, Python, and SUDAAN®. While the same type of tests using different packages yield similar results, different types of Chi-square tests may yield variations in p-values when conducting the same comparison. Sample programming code is included in Appendix for readers’ reference. © This work was authored as part of the Contributor’s official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.

BACKGROUND: Evidence on the association between maternal phenol exposure and inflammation during pregnancy is limited and inconsistent. OBJECTIVE: To evaluate associations between urinary phenol biomarkers and serum inflammatory cytokines across pregnancy, and to examine whether associations vary by trimesters. METHODS: We included 175 pregnant women from the Massachusetts General Hospital Fertility Center and participating in the Environment and Reproductive Health (EARTH) Study (2005-2017), with available data on urinary concentrations of eight phenol biomarkers and serum inflammatory biomarkers, high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Linear regression models were employed to assess the association between individual phenol biomarker concentrations and log-transformed inflammatory cytokine levels, while Bayesian Kernel Machine Regression (BKMR) models were utilized to evaluate phenol biomarker mixtures. Analyses were further stratified by the trimester of sample collection. RESULTS: Overall, detectable urinary ethylparaben was positively associated with serum hsCRP (β: 0.464; 95 % CI: 0.012, 0.917). In trimester-specific analyses, urinary butylparaben was positively associated with hsCRP (β: 0.533; 95 % CI: 0.006, 1.059) in the first trimester, but negatively associated with IL-6 (β: -0.613; 95 % CI: -1.062, -0.164) in the second trimester. Urinary bisphenol A was inversely associated with hsCRP (β: -0.428; 95 % CI: -0.731, -0.125) in the third trimester. CONCLUSIONS: Our findings suggest that exposure to certain phenols may disrupt inflammatory profiles in pregnancy, with effects varying by trimesters. These novel associations underscore the importance of exposure timing when assessing environmental risk factors for maternal and offspring health outcomes.

INTRODUCTION: Gulf War Illness is a chronic multisymptomatic disorder that affects as many as 25-35% of the military personnel who were sent to the Persian Gulf war in 1991. The illness has many debilitating symptoms, including cognitive problems, gastrointestinal symptoms, and musculoskeletal pain. Those so afflicted have been sick for more than 30 years and, therefore, it has become imperative to understand the etiology of Gulf War Illness and then produce treatments to ease the symptoms. We hypothesized that the length of the disease was reflected in epigenetic modification of possibly several genes related to the symptoms. METHODS: We subjected male and female mice from 11 BXD strains to combined corticosterone and the sarin surrogate, diisopropylfluorophosphate, to emulate the physiological stress of war and the potential exposures to organophosphate pesticides and nerve agent in theater. Three hundred days after treatment, we used Methyl-CpG-binding domain sequencing (MBD-seq) to assay genome-wide methylation. RESULTS: The analysis revealed 20 methylated genes, notably Eif2b5, that regulates myelin production. DISCUSSION: Loss of myelin with accompanying musculoskeletal pain is a major symptom of Gulf War Illness. Our work demonstrates multiple genes were methylated by exposure to organophosphates and glucocorticoids. These genes point to biochemical mechanisms that may be targets for therapeutic intervention.

This study assessed resource allocation among registry activities, which may provide insight for efficient collection of high-quality cancer incidence data. We used a multimodal approach and purposively sampled 21 participating population-based cancer registries in the United States to ensure variation across several registries. The registries reported prospective staffing data and retrospective costing data, completing data collection from October 2021 to September 2022, reporting retrospective costing data for July 1, 2020, through June 30, 2021. From lessons learned from prior studies, we engaged participating registries early and throughout the study, ensuring the collection of meaningful, accurate quantitative data, as well as insights not captured quantitatively. Case volume is a major driver of registry costs. (On average, high-volume registries outspend low-volume registries by nearly 3x, annually). Upon examination of registry activities by case volume, we found that the two most resource-intensive registry activities are data acquisition and data processing, which may be addressed by innovations, such as electronic reporting and automation. Innovative data transfer and processing approaches could increase timeliness of data collection and reduce the labor resources required to process manually collected data. Registries adopting these innovations might achieve cost savings, which could make resources available to support other registry activities.

Introduction: There are no national estimates for blood pressure–lowering prescription trends among the U.S. pediatric population. This study describes trends in blood pressure–lowering prescription fills among individuals aged 3–17 years by sex and age group. Methods: Data were obtained from IQVIA's Total Patient Tracker database covering 94% of all outpatient retail prescription fills in the U.S. The key outcome was blood pressure–lowering prescription fills during 2017–2023, utilizing a list of 113 generic medications from 21 drug classes. In addition, a subset of 20 medications recommended in the 2017 American Academy of Pediatrics guideline was examined. Annual population percentage and percentage change compared with 2017 were reported, and average annual percentage change was estimated using Joinpoint regression. Results: From 2017 to 2023, blood pressure–lowering prescription fills among those aged 3–17 years increased slightly from 1.93% (95% CI=1.88%, 1.98%) to 2.09% (95% CI=2.04%, 2.14%). Among males, blood pressure–lowering prescription fills remained stable (between 2.32% and 2.38%; average annual percentage change= −0.3%; p=0.545), whereas fills among females increased by 23.9% (from 1.49% to 1.84%; average annual percentage change=4.16%; p<0.001). The sharpest increase occurred among females aged 13–17 years (from 2.26% to 3.17%; average annual percentage change=6.3%; p<0.001). Prescription fills for guideline-recommended medications either remained stable or declined, with some variation by sex and age group. Conclusions: Results indicate growth in blood pressure–lowering prescription fills, especially among females aged 13–17 years. Increases were driven by medications not included in the 2017 American Academy of Pediatrics guideline, suggesting that blood pressure–lowering medications may be increasingly prescribed for conditions other than pediatric hypertension. © 2025

Acute gastroenteritis (AGE) has one of the highest rates of morbidity and mortality among children under five years old worldwide. It is estimated that 1.7 billion cases of childhood diarrheal diseases occur annually, leading to up to 443,832 deaths. Approximately 90% of these cases are viral, with human norovirus being the main cause in countries that have implemented rotavirus vaccines. The objective of this study was to describe the prevalence and genetic diversity of norovirus in child outpatients and inpatients under five years old at the Regional Hospital of Antofagasta. From 1 January to 31 October 2019, a total of 121 stool samples were collected to detect the presence of norovirus GI and GII using Taqman™-based real-time RT-PCR. Norovirus RNA was detected in 50 (41.3%) samples, of which 96% were typed as GII.4 Sydney (42% GII.4 Sydney[P16] and 54% GII.4 Sydney[P4 New Orleans]). Furthermore, most (92%) of the positive specimens were from children under two years of age and a majority were detected in April (38%) and May (20%). Our findings highlight the high burden of norovirus in hospitalized children with AGE and the importance of molecular strain surveillance to support vaccine development.

Antiviral susceptibility of influenza viruses is monitored by the World Health Organization Global Influenza Surveillance and Response System. This study describes a global analysis of the susceptibility of influenza viruses to neuraminidase (NA) inhibitors (NAIs, oseltamivir, zanamivir, peramivir, laninamivir) and the cap-dependent endonuclease inhibitor (CENI, baloxavir) for three periods (May to May for 2020-2021, 2021-2022 and 2022-2023). In particular, global influenza activity declined significantly in 2020-2021 and 2021-2022 when compared to the pre-pandemic period of COVID-19. Combined phenotypic and NA sequence-based analysis revealed that the global frequency of seasonal influenza viruses with reduced or highly reduced inhibition (RI/HRI) by NAIs remained low, 0.09% (2/2224), 0.12% (27/23465) and 0.23% (124/53917) for 2020-2021, 2021-2022 and 2022-2023, respectively. As in previous years, NA-H275Y in A(H1N1)pdm09 viruses was the most frequent substitution causing HRI by oseltamivir and peramivir. Sequence-based analysis of polymerase acidic (PA) protein supplemented with phenotypic testing revealed low global frequencies of seasonal influenza viruses with reduced susceptibility (RS) to baloxavir, 0.07% (1/1376), 0.05% (9/18380) and 0.12% (48/39945) for 2020-2021, 2021-2022 and 2022-2023, respectively; commonly associated substitutions were PA-I38T/M/L. In Japan, the rate was 3.3% (16/488) during 2022-2023, with 11 A(H3N2) viruses having PA-I38T/M substitutions. For zoonotic viruses, 2.7% (3/111) contained substitutions, one each NA-H275Y, NA-S247N and NA-N295S, associated with RI/HRI NAI phenotypes, and none contained PA substitutions associated with RS to baloxavir. In conclusion, the great majority of seasonal and zoonotic influenza viruses remained susceptible to NAIs and CENI baloxavir.

INTRODUCTION: Sexual violence (SV) affects millions globally and has a well-documented bidirectional association with HIV. Post-exposure prophylaxis (PEP) is a critical, yet often underutilized, HIV prevention tool in post-SV care. Despite its potential impact to reduce HIV transmission, SV care remains an overlooked service delivery point for HIV prevention. The U.S. Centers for Disease Control and Prevention (CDC), as part of the President's Emergency Plan for AIDS Relief (PEPFAR), supports PEP provision within broader post-violence care (PVC) services. Understanding PEP utilization is crucial for optimizing service delivery and HIV prevention efforts. METHODS: Using Monitoring Evaluation and Reporting data from fiscal years 2018-2023, we conducted a descriptive analysis of clients who received PVC and SV services through CDC-supported programming in 14 sub-Saharan African countries. RESULTS: From 2018 to 2023, the annual number of clients receiving any PVC, and specifically SV, services increased by 233% (in 2018, n = 206,764; in 2023, n = 689,349) and 163% (in 2018, n = 42,848; in 2023, n = 112,838), respectively. Fewer than half of SV clients completed PEP (38% in 2018, n = 16,103; 31% in 2023, n = 35,118). Across all years combined, most SV clients (female: 185,414; male: 59,618) were aged 15-19 years. The age band and sex with the lowest proportion of clients completing PEP were males aged 15-19 (4%, n = 2296). CONCLUSIONS: The findings underscore a critical gap between the scaling of SV services and the completion of PEP within violence response programmes. Innovative implementation science approaches may help to identify and address barriers inhibiting effective PEP delivery and uptake within PVC service delivery programmes. Enhancing PEP uptake and completion can support mitigating the bidirectional relationship between violence and HIV acquisition, particularly among vulnerable populations like adolescents and young adults. Low PEP coverage also reflects missed opportunities, particularly among adolescent girls and young women, who experience disproportionate rates of HIV acquisition.

Mozambique's National Blood Transfusion Services (NBTS) is tasked with providing safe and available blood but also conducting systematic screening of at-risk potential donors, notifying seropositive blood donors, and linking them to HIV care and treatment services. Potential blood donors who were deferred from donating following a behavioral risk screening and all blood donors who screened seropositive for HIV were notified and offered linkage to HIV testing, care, and treatment services by community-based organizations. A prospective study among HIV-positive blood donors and deferred donors was conducted from May 2019 to July 2020 at Maputo Central Hospital Blood Bank and the National Reference Blood Center. The associations between testing, initiating care and treatment services among HIV-positive blood donors and prospective deferred donors were estimated using fully Bayesian multivariable logistic models and odds ratios. Among 885 prospective blood donors enrolled, 173 (20%) were deferred due to self-reported high-risk behaviors identified through a screening questionnaire, and 712 (80%) passed the behavioral-risk screening tool, donated, and the blood donation tested positive for HIV. There were more than 2.5 times as many male donors as female donors with a positive HIV test, and among the deferred donors, more than 84% were males. 36% (256/712) of seropositive donors and 35% (61/173) of deferred donors were referred to HIV testing services. 62% (158/256) of seropositive donors and 4.9% (3/61) of deferred donors who were successfully referred were linked to care and treatment services, and 96% (152/158) of these seropositive donors and 100% (3/3) of deferred as high-risk donors initiated antiretroviral therapy (ART). Of the three service organizations used, one outperformed the other two in linking seropositive donors to ART treatment. The NBTS can serve as a critical entry point for identifying HIV-positive persons. Improved implementation of risk behavior screening tools is needed and could contribute to early identification and initiation of ART for potential donors. Innovative strategies and solutions by community-based organizations can be used to improve blood donor notification and linkage to HIV testing and treatment services.

INTRODUCTION: We examined the association of pre-exposure prophylaxis (PrEP) programme retention with the use of daily, event-driven (ED) or regimen switching reported during follow-up at any point prior to discontinuation among men who have sex with men (MSM) in Hanoi, Vietnam. METHODS: Between April 2020 and February 2023, we collected data from PrEP clients at Hanoi Medical University Sexual Health Promotion clinic who were prescribed either ED or daily PrEP at the initial visit; at subsequent visits, clients reported the regimen used since the prior visit. We defined three categories of PrEP use: ED-PrEP exclusively, daily PrEP exclusively and switching regimens. The primary outcome was time to discontinuation in the PrEP programme during the study period, defined as missing a scheduled visit by > 30 days. We performed survival analysis using Kaplan-Meier curves. RESULTS: In total, 2107 people were included: 61.1% (n = 1288) reported exclusive use of daily PrEP, 10.4% (n = 220) reported exclusive use of ED-PrEP and 28.4% (n = 599) reported switching PrEP regimens. Among switchers, 29.40% (n = 176) switched more than once. Furthermore, 82.5% switched from daily to ED-PrEP and 17.5% switched from ED to daily PrEP. The median time to discontinuation in the PrEP programme was 105 days (IQR: 52-182) among those reporting exclusive use of ED-PrEP, 104 days (IQR: 56-274) among those reporting exclusive use of daily PrEP and 163 days (IQR: 101-308) among those who switched. Among switchers, those who switched more than once had a median time to discontinuation in the PrEP programme of 231 days (IQR: 137-380) in comparison to 133 days (IQR: 90-274) for those who switched once. CONCLUSIONS: We provide real-world data from MSM in an HIV PrEP programme in Vietnam that those who switched had longer periods of retention during the study period. Our findings suggest that offering flexible PrEP regimen options may improve engagement and long-term adherence among this population.

BACKGROUND: Patients reporting sexual contact with a person(s) with chlamydia (CT) and/or gonorrhea (NG) are at increased risk of acquiring these sexually transmitted infections (STIs). Presumptive antimicrobial therapy is recommended for sexual contacts, but concerns have been raised about unnecessary antibiotic use. METHODS: We reviewed visits of patients who reported sexual contact to a partner with CT or NG ("contacts") from 1/2021-10/2023 in 10 STI clinics. We calculated CT and NG positivity, stratified by 3 patient groups (women, men who have sex with men [MSM], and men who have sex with women only [MSW]) and symptomatic status. RESULTS: Overall, 11,072 (6.8%) CT and/or NG contacts were identified (7,660 [4.7%] CT contacts and 4,988 [3.1%] NG contacts). CT positivity among CT contacts was 35%; NG positivity among NG contacts was 31%. CT positivity did not differ by symptomatic status across patient groups. NG positivity was higher for symptomatic vs. asymptomatic MSM (34%, 95% confidence interval [CI] 31-37% vs 28% [CI 26-30%]) and MSW (37%, CI 33-41% vs 23%, CI 20-27%), but not in women (38%, CI 33-43% vs 37%, CI 32-42%). CONCLUSIONS: Substantial CT/NG positivity among sexual contacts to CT or NG was observed. Among CT contacts, CT infection was most often detected in MSW; among NG contacts, NG infection was most often detected in women. However, ~60% did not have either CT or NG. The use of point-of-care tests in this population may optimize antimicrobial use while prioritizing individual clinical care.

BACKGROUND: Understanding the population dynamics and geographical range of Aedes aegypti is critically important for arbovirus vector surveillance and control. Little is known about the current distribution and seasonality of Ae. aegypti in Grand Lomé, Togo. We developed an investigation to determine whether Ae. aegypti was present across Lomé communes during a 1-year collection period. METHODS: Mosquito ovitraps (n = 70) were deployed across the 13 communes in the Grand Lomé health region and were examined between May 2022 and April 2023. Generalized linear mixed models (GLMMs) were applied to investigate the relationship between larval collections and seasonality. The European Space Agency (ESA) WorldCover 10 m 2020 product was used to represent different land cover classes and to determine whether sites with higher larval numbers differed from sites with lower numbers. RESULTS: A total of 52,768 Ae. aegypti larvae were collected across the 13 communes of Grand Lomé. The highest incidence of Ae. aegypti larvae was observed in the commune of Bè-Ouest (= 122.74 per 1000 population). Agoè-Nyivé was the commune with the lowest incidence over the entire study period. There was a statistically significant difference in Ae. aegypti larval counts between the rainy and dry seasons. Eight land-use classes were represented by the ESA 10 m product in Grand Lomé, with the built-up category being the most common. We found a significant relationship between larval abundance categories and land cover classes. CONCLUSIONS: This study shows that Ae. aegypti larvae can be found across all communes of the Grand Lomé region in both the rainy and dry seasons, especially in ovitraps surrounded by built-up land cover category. The results of this study could be useful in guiding disease vector surveillance and control efforts due to the potential imminent risk of upcoming dengue outbreaks.

BACKGROUND: Folate plays a critical role during pregnancy, preventing neural tube defects and possibly adverse neurodevelopment. Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals that may decrease folate levels. Although some studies have found associations between PFAS and folate, we are unaware of studies conducted in pregnant women. To address this knowledge gap, we evaluated associations between PFAS and whole blood folate (WBF) in pregnant women. METHODS: We used data from 288 pregnant women in the Health Outcomes and Measures of the Environment (HOME) Study, a pregnancy and birth cohort in the Cincinnati Ohio area. We measured eight serum PFAS and WBF concentrations at 16 weeks' gestation. We used linear regression to estimate the effect of each PFAS on WBF, and quantile-based g-computation and Bayesian kernel machine regression (BKMR) to investigate the joint effect of PFAS on WBF, adjusting for parity, prenatal vitamin intake, maternal race/ethnicity, household income, maternal age, and second trimester smoking status in all models. In addition, we investigated interactions between PFAS using BKMR. RESULTS: We did not observe inverse associations of individual PFAS or their mixture with WBF, nor interactions between PFAS in the BKMR model in pregnant women. CONCLUSION: Future studies could consider WBF measures in late pregnancy to evaluate other periods of susceptibility. Furthermore, as people are exposed to multiple PFAS, future studies should continue to consider joint PFAS exposure.

Hand hygiene (HH) in school settings can reduce the spread of infectious diseases and student absenteeism due to illness. During the COVID-19 pandemic, the World Health Organization recommended HH as a public health measure to prevent disease transmission. Understanding school staff's experiences with school-based programs is important for future program development and improvement. As part of a mixed-methods study, we conducted in-depth interviews in March 2022 with school administrators and teachers at 12 primary schools in Belize, selected based on high gaps in HH resources, to understand HH responsibilities, supplies, and challenges. An intervention was implemented to increase HH knowledge and practices among students, which included environmental nudges, supplemental provision of soap, and HH lesson implementation. Follow-up interviews were conducted in June 2023 among school administrators to garner feedback on the intervention. School staff described roles in teaching and managing HH supplies at both timepoints. The environmental nudges and HH lessons were perceived as helpful, but there were gaps remaining in HH practices, which may be partially influenced by practices and beliefs outside of school. Procurement of HH supplies remained a challenge at some schools due to financial constraints. The feedback from school staff will be valuable for the implementation of future hand hygiene programs in schools.

INTRODUCTION: Data on sexual violence (SV) prevalence in Nigeria is limited; however, 2014 data indicate that 24.8% of females aged 18-24 years experienced SV in childhood and only 3.5% received any form of services. Initiation of post-exposure prophylaxis (PEP) to prevent HIV acquisition following SV is most effective when started immediately and is not recommended after 72 hours. Police stations are often entry points for survivors; however, lengthy processes may result in delays and missed PEP opportunities. Using an ongoing phased approach, we introduced PEP into selected police stations in Nigeria's Federal Capital Territory in order to explore expanding access to time-sensitive HIV prevention within non-health services. METHODS: Our intervention phase consisted of the provision of training of police officers and the provision of PEP starter packs coupled with linkage to referral facilities. During two time periods (pre-intervention: January-March 2023) and (during intervention: July-September 2023), we evaluated routinely reported programme data from 27 U.S. Centers for Disease Control and Prevention-supported health facilities for changes in the provision of SV services and PEP initiation. We used geospatial mapping to assess the proximity of participating health facilities to police stations and to see changes in both SV and PEP service provision. The statistical significance of the difference in PEP uptake proportion during the two periods was determined using the Wilcoxon signed rank test at a 0.05 level of significance. RESULTS: Of the total 27 health facilities, 24 were within a 5-km radius of a participating police station. Total SV service provision increased from 114 cases to 218 cases, representing a 91.2% increase and with most of this increase seen among females. PEP initiation increased by 289.3% at the two time points, with 56 initiations pre-intervention to 218 PEP initiations during the intervention. CONCLUSIONS: Our findings showed promise in increasing immediate access to PEP in non-health services and highlighted the feasibility of police stations and health facilities collaboration to address urgent health needs. There was an overall increase in PEP initiations by referral and non-referral facilities which could be the result of demand creation and increased access at police stations.

BackgroundSchool food environments may play an important role in shaping children's dietary habits, health, and nutrition.ObjectivesThis study aimed to evaluate associations between the school food environment and nutrition among in-school adolescents in Ghana.MethodsData were collected in Ghana in 2022 in a national nutrition and health survey of adolescents attending junior (JHS) and senior high schools (SHS). Foods observed on campus or reported in the dietary recall were aggregated, a composite Adolescent Dietary Diversity Score (ADDS) was derived, and the proportion achieving minimum dietary diversity was estimated. Multi-level regression models were used to assess associations between a ranked school food environment score (FES) and nutrition outcomes.ResultsThe number of food groups served or available for purchase was 6.2 in JHS and 8.1 in SHS (P-value <.0001). The mean (95% CI) FES was 10.9 (10.1, 11.7) at JHS and 14.3 (13.6, 14.9) at SHS. ADDS ranged from 4.1 to 4.8 across strata. Higher FES was positively associated with ADDS and minimum dietary diversity among SHS students and negatively associated with anemia in girls and boys. Girls from high FES schools had 24% lower odds of anemia (OR: 0.76, 95% CI: 0.63, 0.93) while boys had 46% lower odds (OR: 0.54, 95% CI: 0.34, 0.84) compared to students in low FES schools.ConclusionsHigher FES was associated with greater dietary diversity among SHS students and lower odds of anemia in girls and boys, suggesting that the school food environment may play a role in determining nutrition outcomes. | The School Food Environment in Ghana is Related to Dietary Diversity and AnemiaPlain Language SummaryThe foods that children eat while at school have an important impact on their health and nutrition. We collected data among in-school girls and boys aged 10–19 years in Ghana. Students were asked what they had eaten in the last 24 h and were asked questions about their general food practices at school, such as what foods are included in school meals, what foods they typically bring to school, and what foods they buy at school. We also collected blood from students to test for anemia. School leaders were interviewed to better understand school programs and activities related to food and nutrition, including questions about the school meals program and food vendors present on campus. We used the information we gathered from these interviews to create a school food environment score. We found that, on average, students consumed fewer than 5 out of 10 food groups on a given day. We also found that senior high schools tended to have a larger variety of foods available and had a higher food environment score compared to junior high schools. In schools with higher food environment scores, students were more likely to eat a larger variety of foods and less likely to have anemia. These findings may be used to improve existing nutrition programs in Ghana and to design future programs focused on the health of school children. | eng

The Kessler 6 (K6) scale has been widely used to screen for serious mental illness (SMI) in general populations. Given that populations with high burden of HIV may be more likely to experience poor mental health outcomes, it is important to validate measures used to assess SMI among these groups. Using data from CDC's National HIV Behavioral Surveillance (NHBS) system in the United States, we examined psychometric characteristics of the K6 scale, including exploratory factor analysis, scale reliability, construct validity, and review of interviewer feedback to explore scale performance in the field. Analyses confirmed a single factor structure and demonstrated that the K6 scale had high internal consistency and construct validity. Although interviewers noted that the effort item was difficult for some participants to understand, psychometric properties were not greatly improved with the deletion of the item. The results of this analysis suggest that the K6 scale is appropriate for use among NHBS populations with a high burden of HIV, including persons who inject drugs, heterosexually active adults at increased risk for HIV infection, women who exchange sex for money or drugs, and gay, bisexual, and other men who have sex with men.

INTRODUCTION: Given the increasing usage of vaping during pregnancy and limited longitudinal health-related data, there is an urgent need to assess the potential risks of vaping. AIMS AND METHODS: A cross-sectional study was conducted among pregnant UK adults (n = 140). Five study groups were purposively recruited: exclusive-smokers (n = 38), exclusive-vapers (former smokers) (n = 35), dual users of smoking and vaping (n = 25), dual users of smoking and nicotine replacement therapy (n = 10), and "never-users" of nicotine or tobacco products (n = 32). Sociodemographic, smoking, and vaping characteristics were assessed. Participants' urine samples were analyzed for biomarkers of exposure to tobacco alkaloids, and toxicants, including 14 volatile organic compounds (VOCs), tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), heavy metals (cadmium, lead, chromium, nickel, copper, and tin) and a polycyclic aromatic hydrocarbon (2-naphthol). Regression analysis was used to compare biomarkers by group. RESULTS: Nicotine levels varied across product users, but not significantly. After controlling for confounders, for most VOCs, biomarker levels were similar for exclusive-vapers and never-users and significantly lower than for exclusive-smokers and any dual users. There were generally no significant differences between groups for 2-naphthol or heavy metals. For NNAL, cadmium and chromium, a high percentage of values were below the limit of detection, making analyses unreliable. CONCLUSIONS: During pregnancy, former smokers who are established exclusive vapers, but not dual users, had levels of selected VOCs that were substantially lower than those for exclusive smokers and comparable with those who have never used nicotine or tobacco products. IMPLICATIONS: Based on the biomarkers assessed in this study, during pregnancy, on average, exclusive-vapers are likely to have similar levels of exposure to selected VOCs as never-users and far lower levels than exclusive-smokers or dual-users (although dual-vaping and smoking may result in less exposure than exclusive-smoking). This provides preliminary information about exposure to vaping during pregnancy and suggests that, for some biomarkers, exclusive vaping is likely to result in lower exposures than exclusive smoking or dual-use. There may be exposure to other vaping toxicants that were not explored in this study. Studies are needed to assess pregnancy and birth outcomes as well as early life effects.

West Nile virus (WNV) causes thousands of arboviral infections in the United States each year. Patients with immune-compromising conditions and elderly people are at higher risk of severe WNV neuroinvasive disease (WNND). Despite its broad endemicity nationwide, no U.S. Food and Drug Administration-approved vaccine or therapeutic treatments exist. We summarized existing peer-reviewed literature on the preclinical development of monoclonal antibody (MAb) prophylaxis and therapeutics for the prevention and treatment of WNND. Five bibliographical databases (CINAHL, Cochrane Library, Embase, MEDLINE, and Scopus) were searched for applicable research studies performed from 1 January 1998 to 1 May 2025. In total, 2347 titles and abstracts were screened, 263 full-text publications reviewed, and 25 studies included. Studies included detailed preclinical development and evaluations of MAbs targeting the envelope (E) protein (n = 13), other viral proteins (n = 3), flaviviral cross-protective monoclonal antibodies (n = 4), and novel antibody configurations or delivery methods (n = 5). The most well-studied MAb, E16, targeting E- Domain III (E-DIII), was effective at inhibiting and treating WNND in experimental animal models. No work investigated ways to traffic therapeutic antibodies across the blood-brain barrier. This review summarizes the current research in the development of monoclonal antibody therapeutics for WNV and addresses gaps in the knowledge for future consideration.

Monitoring the zoonotic potential of emerging SARS-CoV-2 variants in animals is a critical tool to protect public health. We conducted a longitudinal study in 47 households reporting people with COVID-19 in Texas from January to July 2022, during the first Omicron wave. We evaluated 105 people and 100 of their companion animals for SARS-CoV-2 infection at three sequential sampling events, starting 0-5 days after the first reported diagnosis of COVID-19 in the house. SARS-CoV-2 RNA was detected in 68% of people from 43 households; 95.5% of people had antibodies to SARS-CoV-2. Dogs were the only animal species positive by RT-qPCR (5.4%; 3/55), and their viral loads were consistently lower compared with those from household members. Additionally, infected dogs did not yield infectious virus. Clusters of Omicron BA.1.1, BA.2.3.4, and BA.5.1.1 in people, dogs, and a dog food bowl confirmed human-to-dog transmission within households, with no evidence of onward transmission from the infected dogs. Eleven dogs (n = 55) and two cats (n = 26) had neutralizing antibodies against SARS-CoV-2. Overall, infection was not associated with clinical signs in pets; only two animals that tested negative for SARS-CoV-2 were reported to be sick. Nearly one-third (30.2%) of households with active COVID-19 had pets exposed to SARS-CoV-2, similar to our pre-Omicron studies; however, the incidence of infection in cats was lower compared with pre-Omicron. These differences suggest that the zoonotic transmission dynamics in households may differ based on variants.IMPORTANCESARS-CoV-2 infects a broad diversity of mammals, with companion dogs and cats at risk of infection via close contact with infectious owners. Longitudinal studies sampling pets and their owners over time are essential to understanding within-household SARS-CoV-2 transmission dynamics. Our repeated sampling in households with people reporting COVID-19 found that 68% of the people in 43 households had active SARS-CoV-2 infection during at least one of the three sampling events. Although none of the 27 cats were positive, 3/55 dogs had active infections. Household clusters of three different Omicron subvariants were involved in these human-to-dog transmission events, and our data suggest reduced infection in pets during Omicron transmission compared with pre-Omicron waves. Protecting pets from SARS-CoV-2 infection remains important, as viral evolution can be accompanied by changes in the infectiousness of different hosts.

INTRODUCTION: Arthritis is a common chronic disease, affecting an estimated 53.2 million adults (21.2%) in the US. "Arthritis" is a general term, describing over 100 conditions with different etiologies, pathogeneses, symptoms, and treatments. Few studies have examined the prevalence and distribution of arthritis subtypes in the US. METHODS: We used National Health and Nutrition Examination Survey data from 2017 to March 2020 to estimate the prevalence of arthritis subtypes overall and by sociodemographic characteristics. RESULTS: The overall prevalence of any type of diagnosed arthritis among US adults aged 20 years or older in this study was 27.9% (67.1 million). Among adults with diagnosed arthritis, osteoarthritis (49.6%, 33.2 million) was the most common arthritis subtype, followed by rheumatoid arthritis (15.8%, 10.6 million) and psoriatic arthritis (1.4%, 1.0 million). More than 1 in 10 reported some other type of unlisted arthritis (11.5%, 7.7 million), and 1 in 5 did not know their arthritis subtype (21.6%, 14.4 million). Prevalence of not knowing arthritis type was approximately 1 in 4 for adults identifying as non-Hispanic Black (26.7%) or other Hispanic (29.5%) and for adults who reported low family income (26.7%) and was approximately 1 in 3 for adults identifying as Mexican American (31.9%), having less than a high school education (31.8%), or not having health insurance (36.1%). CONCLUSION: Understanding arthritis type is important for improving treatment, self-management, and health outcomes associated with arthritis. Improving organizational and personal health literacy are potential strategies that may reduce the prevalence of not knowing arthritis type.