Foodborne hepatitis A illnesses and outbreaks have been associated with consumption of ready-to-eat foods contaminated with the feces of person(s) shedding hepatitis A virus (HAV). Outbreaks have been linked to fresh and frozen produce imported from countries where HAV is endemic, hygiene and sanitation are inadequate, or food safety standards are lacking or unenforced. In 2022 and 2023, federal, state, and international partners investigated two multijurisdictional outbreaks of infections involving the same HAV genotype IA strain linked to fresh and frozen organic strawberries sourced from a single grower in Baja California, Mexico. These resulted in 39 reported cases in the U.S. and Canada, 21 hospitalizations, and no reported deaths. The United States Food and Drug Administration (FDA), Canadian Food Inspection Agency, and U.S. state partners conducted traceback investigations for fresh strawberries in 2022, while FDA and U.S. state partners traced back frozen strawberries in 2023. Based on the traceback investigations, implicated strawberries were harvested during the 2022 growing season and sold to fresh and frozen berry markets. During a farm inspection in Mexico in 2023, gaps were observed in agricultural practices that could have contributed to contamination of strawberries with HAV. FDA did not detect HAV in the two frozen strawberry samples linked to the recalled lots or environmental water samples collected at the implicated grower in 2023; no samples were collected during the 2022 investigation. Indicator organisms associated with human fecal contamination (male-specific coliphage and crAssphge) were detected in environmental water. Challenges in these investigations included limited recall of food exposures, exposures associated with multiple purchase dates, commingling of strawberries within the frozen market supply chains, and complexities with communicating these outbreak investigations to the public.

Chemical release incidents in the United States involve hazardous chemicals that can harm nearby communities. A historical tracking of these chemical release incidents from 1991 to 2014 across up to 16 states has been conducted by The Agency for Toxic Substances and Disease Registry (ATSDR), utilizing the Hazardous Substances Emergency Events Surveillance (HSEES) and the National Toxic Substance Incidents Program (NTSIP) systems. By analyzing surveillance data, patterns of these different chemical releases can be identified to develop and construct a health-protective course of action. Physiologically Based Pharmacokinetic (PBPK) models can simulate chemical exposures during acute chemical incidents. For a retrospective study of an acute chemical release in 2012, we examined the components necessary to integrate PBPK-modeled exposure assessments in ATSDR's Assessment of Chemical Exposure (ACE) program. We focused on data from a published investigation of vinyl chloride (VC) exposure to assess the utility of PBPK in evaluating exposures among residential populations near the release site. The initial estimate from the real-time air monitoring at the release site revealed that air levels greatly exceeded the Acute Exposure Guideline Levels (AEGL) of 1200 ppm, with PBPK models predicting corresponding VC blood levels of 3.17 mg/L. "Real-time" and "after-action" air modeling estimated VC levels at various distances from the release site over time. PBPK modeling provided insight into possible residential blood levels of VC over several days following the incident. These findings indicate that PBPK modeling could be valuable for reconstructing exposure scenarios associated with acute chemical releases.

BACKGROUND: A petroleum leak into the Joint Base Pearl Harbor-Hickam water system on Oahu, Hawaii in November 2021 contaminated the drinking water of approximately 93,000 users, causing many to relocate for months. Perceptions of health and wellbeing were captured using the Centers for Disease Control/Agency for Toxic Substances and Disease Registry (CDC/ATSDR) Assessment of Chemical Exposures (ACE) cross-sectional survey in collaboration with the Hawaii Department of Health (HDOH). METHODS: Responses from the ACE online survey of community members, businesses, schools, health care and veterinary care organizations during the contamination event, containing quantitative questions and qualitative information from an open text field, were analyzed. Separately, a qualitative key informant questionnaire was administered to community establishments. Thematic content analysis was used to analyze and identify prominent themes from the ACE open text field and the key informant responses that were triangulated by the quantitative data when the themes aligned. RESULTS: Six major themes of disruption, communication, trust, stress, support, and ongoing needs were identified. Burdensome logistics from obtaining alternate water, negative financial impacts from relocation or losing business, distrust of information, perceived lack of support from response entities and uncertainty of long-term health impact caused significant disruption, stress and mental health. Individuals reported needing water, shelter, and mental health care while establishments wanted financial reimbursement and a resolution. CONCLUSIONS: The findings show that environmental disasters have significant disruptive and mental health impacts from stress. Identified themes can inform and improve emergency response and communication strategies and increase trust with community members during and after large chemical exposure events.

The article discusses the Chemical Exposures (ACE) Program as of November 2023. Topics covered include the improvement and adaptation of the ACE Toolkit over the years for various environmental uses, and the use of toolkits for distribution of online surveys and investigations of chemical exposure-related data. Also noted is the rapid collection of data to guide response and recovery efforts.

BACKGROUND: In 2021, a large petroleum leak contaminated a water source that supplied drinking water to military and civilians in Oahu, Hawaii. METHODS: We conducted an Assessment of Chemical Exposures (ACE) survey and supplemented that information with complementary data sources: (1) poison center caller records; (2) emergency department visit data; and (3) a key informant questionnaire. RESULTS: Among 2,289 survey participants, 86% reported ≥1 new or worsening symptom, 75% of which lasted ≥30 days, and 37% sought medical care. Most (n = 1,653, 72%) reported new mental health symptoms. Among equally observable symptoms across age groups, proportions of children ≤2 years experiencing vomiting, runny nose, skin rashes, and coughing (33, 46, 56, and 35%, respectively) were higher than other age groups. Poison center calls increased the first 2 weeks after the contamination, while emergency department visits increased in early December 2021. Key informant interviews revealed themes of lack of support, mental health symptoms, and long-term health impact concerns. DISCUSSION: This event led to widespread exposure to petroleum products and negatively affected thousands of people. Follow-up health surveys or interventions should give special consideration to longer-term physical and mental health, especially children due to their unique sensitivity to environmental exposures.

Confronted with the challenge of understanding population-level processes, disease ecologists and epidemiologists often simplify quantitative data into distinct physiological states (e.g. susceptible, exposed, infected, recovered). However, data defining these states often fall along a spectrum rather than into clear categories. Hence, the host-pathogen relationship is more accurately defined using quantitative data, often integrating multiple diagnostic measures, just as clinicians do to assess their patients. We use quantitative data on a bacterial infection (Leptospira interrogans) in California sea lions (Zalophus californianus) to improve both our individual-level and population-level understanding of this host-pathogen system. We create a “host-pathogen space” by mapping multiple biomarkers of infection (e.g. serum antibodies, pathogen DNA) and disease state (e.g. serum chemistry values) from 13 longitudinally sampled, severely ill individuals to visualize and characterize changes in these values through time. We describe a clear, unidirectional trajectory of disease and recovery within this host-pathogen space. Remarkably, this trajectory also captures the broad patterns in larger cross-sectional datasets of 1456 wild sea lions in all states of health. This mapping framework enables us to determine an individual’s location in their time-course since initial infection, and to visualize the full range of clinical states and antibody responses induced by pathogen exposure, including severe acute disease, chronic subclinical infection, and recovery. We identify predictive relationships between biomarkers and outcomes such as survival and pathogen shedding, and in certain cases we can impute values for missing data, thus increasing the size of the useable dataset. Mapping the host-pathogen space and using quantitative biomarker data provides more nuanced approaches for understanding and modeling disease dynamics in a system, yielding benefits for the clinician who needs to triage patients and prevent transmission, and for the disease ecologist or epidemiologist wishing to develop appropriate risk management strategies and assess health impacts on a population scale.Author Summary A pathogen can cause a range of disease severity across different host individuals, and these presentations change over the time-course from infection to recovery. These facts complicate the work of epidemiologists and disease ecologists seeking to understand the factors governing disease spread, often working with cross-sectional data. Recognizing these facts also highlights the shortcomings of classical approaches to modeling infectious disease, which typically rely on discrete and well-defined disease states. Here we show that by analyzing multiple biomarkers of health and infection simultaneously, treating these values as quantitative rather than binary indicators, and including a modest amount of longitudinal sampling of hosts, we can create a map of the host-pathogen interaction that shows the full spectrum of disease presentations and opens doors for new insights and predictions. By accounting for individual variation and capturing changes through time since infection, this mapping framework enables more robust interpretation of cross-sectional data; e.g., to detect predictive relationships between biomarkers and key outcomes such as survival, or to assess whether observed disease is associated with the pathogen of interest. This approach can help epidemiologists, ecologists and clinicians to better study and manage the many infectious diseases that exhibit complex relationships with their hosts.

When an influenza pandemic emerges, temporary school closures and antiviral treatment may slow virus spread, reduce the overall disease burden, and provide time for vaccine development, distribution, and administration while keeping a larger portion of the general population infection free. The impact of such measures will depend on the transmissibility and severity of the virus and the timing and extent of their implementation. To provide robust assessments of layered pandemic intervention strategies, the Centers for Disease Control and Prevention (CDC) funded a network of academic groups to build a framework for the development and comparison of multiple pandemic influenza models. Research teams from Columbia University, Imperial College London/Princeton University, Northeastern University, the University of Texas at Austin/Yale University, and the University of Virginia independently modeled three prescribed sets of pandemic influenza scenarios developed collaboratively by the CDC and network members. Results provided by the groups were aggregated into a mean-based ensemble. The ensemble and most component models agreed on the ranking of the most and least effective intervention strategies by impact but not on the magnitude of those impacts. In the scenarios evaluated, vaccination alone, due to the time needed for development, approval, and deployment, would not be expected to substantially reduce the numbers of illnesses, hospitalizations, and deaths that would occur. Only strategies that included early implementation of school closure were found to substantially mitigate early spread and allow time for vaccines to be developed and administered, especially under a highly transmissible pandemic scenario.

Haul truck fatal accidents and injuries continue to be a significant concern for the mining industry. However, the availability of high-quality training materials continues to be limited. Near-miss incident accounts, if packaged well, could help fill this gap, because for every fatality, there are hundreds of reportable accidents and thousands of undocumented near misses. Researchers from the National Institute for Occupational Safety and Health (NIOSH) collected detailed accounts of 21 near-miss incidents in virtual interviews with mineworkers at surface mining operations across the country. From these interviews, researchers created four simulation videos using the Unity game engine. The simulation videos bring these events to life through first-person retelling and various visual perspectives of actual events. Each video exemplifies a critical safety message and a common haul truck hazard. This paper describes the process of taking narratives and turning them into impactful visual stories using graphic simulation. NIOSH plans to co-release these simulation videos with the Mine Safety and Health Administration (MSHA) to the mining industry to raise awareness and ultimately help reduce haul truck-related accidents and fatalities in mining.

After a chemical fire, an investigation assessed health effects by using syndromic surveillance to monitor emergency department (ED) visits, a general health survey to assess the general public, and a first responders health survey to assess first responders. A total of four separate multivariable logistic regression models were developed to examine associations between reported exposure to smoke, dust, debris, or odor with any reported symptom in the general public. Syndromic surveillance identified areas with increased ED visits. Among general health survey respondents, 45.1% (911 out of 2,020) reported at least one symptom. Respondents reporting exposure to smoke, dust, debris, or odor had 4.5 (95% confidence interval (CI) [3.7, 5.5]), 4.6 (95% CI [3.6, 5.8]), 2.0 (95% CI [1.7, 2.5]), or 5.8 (95% CI [4.7, 7.3]) times the odds of reporting any symptom compared with respondents not reporting exposure to smoke, dust, debris, or odor, respectively. First responders commonly reported contact with material and being within 1 mi of the fire ≥5 hr; 10 out of 31 of first responders reported at least one symptom. There was high symptom burden reported after the fire. Results from our investigation might assist the directing of public health resources to effectively address immediate community needs and prepare for future incidents. © 2023, National Environmental Health Association. All rights reserved.

On June 14, 2021, an industrial manufacturing facility in Winnebago County, Illinois caught fire and released smoke, dust, and debris, requiring evacuation of the area in the vicinity of the facility for 4 days. Following the emergency response, the Illinois Department of Public Health (IDPH) and Winnebago County Health Department (WCHD) requested assistance from the Agency for Toxic Substances and Disease Registry (ATSDR) to conduct a community Assessment of Chemical Exposure (ACE). That assessment found that almost one half of respondents reported symptoms during the 2 weeks after the fire (1). | | One year after the fire, IDPH and WCHD invited ATSDR to conduct a follow-up ACE investigation to assess ongoing health impacts. WCHD and ATSDR emailed a modified survey to all 2,030 previous 2021 survey respondents, through the existing electronic system, to collect information related to ongoing exposure and mental and physical health symptoms. This investigation team also conducted a total of 22 semistructured interviews to collect open-ended responses to questions regarding mental health symptoms and community needs. Nine residents of a neighborhood adjacent to the fire site were interviewed in-person and 13 survey respondents who expressed interest in participating were interviewed by phone.

In Spring 2021, the highly transmissible SARS-CoV-2 Delta variant began to cause increases in cases, hospitalizations, and deaths in parts of the United States. At the time, with slowed vaccination uptake, this novel variant was expected to increase the risk of pandemic resurgence in the US in summer and fall 2021. As part of the COVID-10 Scenario Modeling Hub, an ensemble of nine mechanistic models produced six-month scenario projections for July-December 2021 for the United States. These projections estimated substantial resurgences of COVID-19 across the US resulting from the more transmissible Delta variant, projected to occur across most of the US, coinciding with school and business reopening. The scenarios revealed that reaching higher vaccine coverage in July-December 2021 reduced the size and duration of the projected resurgence substantially, with the expected impacts was largely concentrated in a subset of states with lower vaccination coverage. Despite accurate projection of COVID-19 surges occurring and timing, the magnitude was substantially underestimated 2021 by the models compared with the of the reported cases, hospitalizations, and deaths occurring during July-December, highlighting the continued challenges to predict the evolving COVID-19 pandemic. Vaccination uptake remains critical to limiting transmission and disease, particularly in states with lower vaccination coverage. Higher vaccination goals at the onset of the surge of the new variant were estimated to avert over 1.5 million cases and 21,000 deaths, though may have had even greater impacts, considering the underestimated resurgence magnitude from the model.

In late November 2021, the Hawaii Department of Health (HDOH) received reports from Oahu residents of a fuel-like odor coming from their drinking water (1), which was later determined to be related to a November 20, 2021, petroleum (jet fuel) leak at the Red Hill Bulk Fuel Storage Facility. The petroleum leak contaminated the Joint Base Pearl Harbor-Hickam water system,* which supplies an estimated 9,694 civilian and military households (2), in addition to schools and workplaces. HDOH issued a drinking water advisory on November 30, 2021 (1), which was not lifted for all affected zones until March 18, 2022.† Persons in thousands of households were offered temporary housing, and alternative drinking water was provided to users of affected water. HDOH requested epidemiologic assistance (Epi-Aid) from CDC/Agency for Toxic Substances and Disease Registry (ATSDR) to assess the incident’s impact on civilian health in the affected area; this was later expanded to include military-affiliated persons.

On June 14, 2021, an industrial fluid and grease manufacturing facility in Winnebago County, Illinois, (population = 285,350) (1) caught fire, releasing smoke, dust, and debris for 4 days and prompting local authorities to issue a precautionary 1-mile (1.5-km) evacuation order and 3-mile (5-km) masking advisory around the location of the facility during this time. Review of Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) data during this time demonstrated increased emergency department visits in five zip codes downwind of the fire. In response, the Winnebago County Health Department (WCHD), Illinois Department of Public Health, and Agency for Toxic Substances and Disease Registry (ATSDR) collaborated to investigate the fire’s effect on human health.

OBJECTIVE: The aim of the study was to assess occupational health effects 1 month after responding to a natural gas pipeline explosion. METHODS: First responders to a pipeline explosion in Kentucky were interviewed about pre- and post-response health symptoms, post-response health care, and physical exertion and personal protective equipment (PPE) use during the response. Logistic regression was used to examine associations between several risk factors and development of post-response symptoms. RESULTS: Among 173 first responders involved, 105 (firefighters [58%], emergency medical services [19%], law enforcement [10%], and others [12%]) were interviewed. Half (53%) reported at least 1 new or worsening symptom, including upper respiratory symptoms (39%), headache (18%), eye irritation (17%), and lower respiratory symptoms (16%). The majority (79%) of symptomatic responders did not seek post-response care. Compared with light-exertion responders, hard-exertion responders (48%) had significantly greater odds of upper respiratory symptoms (aOR: 2.99, 95% CI: 1.25-7.50). Forty-four percent of responders and 77% of non-firefighter responders reported not using any PPE. CONCLUSIONS: Upper respiratory symptoms were common among first responders of a natural gas pipeline explosion and associated with hard-exertion activity. Emergency managers should ensure responders are trained in, equipped with, and properly use PPE during these incidents and encourage responders to seek post-response health care when needed.

Powered haulage continues to be a large safety concern for the mining industry, accounting for approximately 50% of the mining fatal accidents every year. Among these fatal accidents, haul-truck-related accidents are the most common, with 6 of 28 and 6 of 27 fatal accidents occurring in 2017 and 2018, respectively. To better understand why these accidents continue to occur and what can be done to prevent them, researchers reviewed the 91 haul-truck-related fatal accidents that occurred in the USA from 2005 to 2018 and performed bow-tie analyses using the final reports published by the Mine Safety and Health Administration. The analyses explore the context of the accidents with a focus on the initiating event, event outcome, hazards present, and possible preventative and mitigative controls. Overall, the vast majority of the accidents resulted in a haul truck colliding with the environment, and the majority of these events were initiated by loss of situational awareness or loss of control. The majority of the hazards were related to design and organizational controls. The results of this study suggest a need to investigate operator decision-making and organizational controls and to focus on improving design and operation controls such as mine design and operational procedures.

Confronted with the challenge of understanding population-level processes, disease ecologists and epidemiologists often simplify quantitative data into distinct physiological states (e.g. susceptible, exposed, infected, recovered). However, data defining these states often fall along a spectrum rather than into clear categories. Hence, the host-pathogen relationship is more accurately defined using quantitative data, often integrating multiple diagnostic measures, just as clinicians do to assess their patients. We use quantitative data on a major neglected tropical disease (Leptospira interrogans) in California sea lions (Zalophus californianus) to improve individual-level and population-level understanding of this Leptospira reservoir system. We create a "host-pathogen space" by mapping multiple biomarkers of infection (e.g. serum antibodies, pathogen DNA) and disease state (e.g. serum chemistry values) from 13 longitudinally sampled, severely ill individuals to characterize changes in these values through time. Data from these individuals describe a clear, unidirectional trajectory of disease and recovery within this host-pathogen space. Remarkably, this trajectory also captures the broad patterns in larger cross-sectional datasets of 1456 wild sea lions in all states of health but sampled only once. Our framework enables us to determine an individual's location in their time-course since initial infection, and to visualize the full range of clinical states and antibody responses induced by pathogen exposure. We identify predictive relationships between biomarkers and outcomes such as survival and pathogen shedding, and use these to impute values for missing data, thus increasing the size of the useable dataset. Mapping the host-pathogen space using quantitative biomarker data enables more nuanced understanding of an individual's time course of infection, duration of immunity, and probability of being infectious. Such maps also make efficient use of limited data for rare or poorly understood diseases, by providing a means to rapidly assess the range and extent of potential clinical and immunological profiles. These approaches yield benefits for clinicians needing to triage patients, prevent transmission, and assess immunity, and for disease ecologists or epidemiologists working to develop appropriate risk management strategies to reduce transmission risk on a population scale (e.g. model parameterization using more accurate estimates of duration of immunity and infectiousness) and to assess health impacts on a population scale.

Malaria caused by Plasmodium falciparum remains the leading single-agent cause of mortality in children1, yet the promise of an effective vaccine has not been fulfilled. Here, using our previously described differential screening method to analyse the proteome of blood-stage P. falciparum parasites2, we identify P. falciparum glutamic-acid-rich protein (PfGARP) as a parasite antigen that is recognized by antibodies in the plasma of children who are relatively resistant—but not those who are susceptible—to malaria caused by P. falciparum. PfGARP is a parasite antigen of 80 kDa that is expressed on the exofacial surface of erythrocytes infected by early-to-late-trophozoite-stage parasites. We demonstrate that antibodies against PfGARP kill trophozoite-infected erythrocytes in culture by inducing programmed cell death in the parasites, and that vaccinating non-human primates with PfGARP partially protects against a challenge with P. falciparum. Furthermore, our longitudinal cohort studies showed that, compared to individuals who had naturally occurring anti-PfGARP antibodies, Tanzanian children without anti-PfGARP antibodies had a 2.5-fold-higher risk of severe malaria and Kenyan adolescents and adults without these antibodies had a twofold-higher parasite density. By killing trophozoite-infected erythrocytes, PfGARP could synergize with other vaccines that target parasite invasion of hepatocytes or the invasion of and egress from erythrocytes.

PROBLEM/CONDITION: Every year in the United States, thousands of toxic substance incidents harm workers, first responders, and the public with the potential for catastrophic consequences. Surveillance data enable public health and safety professionals to understand the patterns and causes of these incidents, which can improve prevention efforts and preparation for future incidents. PERIOD COVERED: 2010-2014. DESCRIPTION OF SYSTEM: In 2010, the Agency for Toxic Substances and Disease Registry (ATSDR) initiated the National Toxic Substance Incidents Program (NTSIP), and it was retired in 2014. Nine state health departments participated in NTSIP surveillance: California, Louisiana, North Carolina, New York, Missouri, Oregon, Tennessee, Utah, and Wisconsin. The states conducted surveillance on acute toxic substance incidents, defined as an uncontrolled or illegal acute (lasting <72 hours) release of any toxic substance including chemical, biologic, radiologic, and medical materials. Surveillance focused on associated morbidity and mortality and public health actions. This report presents an overview of NTSIP and summarizes incidents and injuries from the nine participating states during 2010-2014. RESULTS: During 2010-2014, participating state health departments reported 22,342 incidents, of which 13,529 (60.6%) met the case definition for acute toxic substance incidents, and included 6,635 injuries among 5,134 injured persons, of whom 190 died. A trend analysis of the three states participating the entire time showed a decrease in the number of incidents with injuries. NTSIP incidents were 1.8 times more likely and injured persons were 10 times more likely to be associated with fixed facilities than transportation. Natural gas, carbon monoxide, ammonia, and chemicals used in illegal methamphetamine production were the most frequent substances in fixed-facility incidents. Sodium and potassium hydroxide, hydrochloric acid, natural gas, and sulfuric acid were the most frequent substances in transportation-related incidents. Carbon monoxide was the most frequent substance in incidents with a large number of injured persons, and chemicals used in illegal methamphetamine production were the most frequent substance in incidents involving decontamination. Incidents most frequently occurred during normal business days (Monday through Friday) and hours (6:00 a.m.-5:59 p.m.) and warmer months (March-August). The transportation and warehousing industry sector had the largest number of incidents (4,476); however, most injured persons were injured in their private residences (1,141) or in the industry sectors of manufacturing (668), educational services (606), and real estate rental and leasing (425). The most frequently injured persons were members of the public (43.6%), including students. Injured first responders, particularly police, frequently were not wearing any chemically protective equipment. Respiratory system problems (23.9%) were the most frequently reported symptoms among injured persons and, in a related finding, volatilization was the most frequent type of release in incidents with injured persons. INTERPRETATION: Industrial and transportation incidents occur frequently and have the potential for catastrophic outcomes. However, exposures to toxic substances occur frequently in other settings. Carbon monoxide, natural gas, and chemicals used in illegal methamphetamine production are commonly found in places where persons live, work, attend school, and recreate and are large contributors to incidents affecting the public. Having active NTSIP state surveillance programs did appear to improve the incidents with morbidity and/or mortality, but these programs have ended. PUBLIC HEALTH ACTION: Archived NTSIP public use data are available to download from the website for analysis. There are also many publications and reports on the website to help understand chemical risks. In addition, jurisdictions might choose to collect surveillance data themselves in a similar manner to what NTSIP states did. Chemical incident surveillance data can be used by public health and safety practitioners, worker representatives, emergency planners, preparedness coordinators, industries, and emergency responders to prepare for and prevent chemical incidents and injuries. As noted by the U.S. Chemical Safety Board, more action needs to be taken to prevent large industrial incidents. Although preventing such incidents might not be in the realm of public health, describing the public health implications and preparing for them is. Another important finding of NTSIP is that industrial incidents are only part of the problem. For example, a large number of persons were injured in a private residence or vehicle (22.2%) and an educational facility (11.8%). Public health professionals must resourcefully target prevention and preparedness to protect vulnerable populations in locations where they might spend time (e.g., schools, daycares, nursing homes, recreational areas, jails, prisons, and hospitals). Reducing the threat of chemical incidents and injuries in the United States will require a concerted effort with a variety of stakeholders including industry and labor, responder groups, policymakers, academia, and citizen advocacy groups.

On April 25, 2019, a farm tractor towing two 2-ton ammonia tanks on a county road in Lake County, Illinois, experienced a mechanical failure that resulted in the release of anhydrous ammonia, a colorless, pungent, irritating gas that can cause severe respiratory and ocular damage (1). Approximately 80% of anhydrous ammonia produced in the United States is used as a fertilizer in agriculture (1). Eighty-three persons, including first responders, motorists, and neighborhood residents, were evaluated at area hospitals because of exposure to the gas. Two weeks after the release, the Agency for Toxic Substances and Disease Registry (ATSDR) and CDC's National Center for Environmental Health (NCEH) collaborated with the Lake County Health Department and the Illinois Department of Public Health on an investigation using ATSDR's Assessment of Chemical Exposures program to describe the release, review the emergency response, and determine health effects associated with the exposure. First responders, community residents, and hospital personnel reported communication challenges related to the nature of the gas release and effective protective measures. Among the 83 persons evaluated at six area hospitals for effects of the chemical release, 14 (17%) were hospitalized, including eight (10%) who were admitted to the intensive care unit (ICU), seven (8%) of whom required endotracheal intubation and mechanical ventilation; no deaths occurred. In addition, ICU health care providers experienced symptoms of secondary exposure. The National Institute for Occupational Safety and Health's Emergency Responder Health Monitoring and Surveillance Program has specific recommendations and tools to protect responders during all phases of a response (2). Hospitals also need to review institutional policies and procedures for chemical mass casualty events, including decontamination (3). Prompt and correct identification of hazardous material (hazmat) events, and clear communication among responding entities, including on-scene and hospital responders, is important to ensure effective response after a chemical release.

Background: Rotavirus (RV) is a leading cause of severe gastroenteritis globally and can cause substantial morbidity associated with gastroenteritis in children <5years of age. Orally administered live-attenuated RV vaccines offer protection against disease but vaccination efforts have been hampered by high manufacturing costs and the need to maintain a cold chain. Methods: A subset of Vero cell host genes was identified by siRNA that when knocked down increased RV replication and these anti-viral host genes were individually deleted using CRISPR-Cas9. Results: Fully-sequenced gene knockout Vero cell substrates were assessed for increased RV replication and RV vaccine antigen expression compared to wild type Vero cells. The results showed that RV replication and antigen production were logs higher in Vero cells having an EMX2 gene deletion compared to other Vero cell substrates tested. Conclusions: We used siRNAs to screen for host genes that negatively affected RV replication, then CRISPR-Cas9 gene editing to delete select genes. The gene editing led to the development of enhanced RV vaccine substrates supporting a potential path forward for improving RV vaccine production.

BACKGROUND: General population surveys are increasingly offering broader response options for questions on sexual orientation-for example, not only gay or lesbian, but also "something else" (SE) and "don't know" (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers studying sexual orientation-based disparities face difficult methodological trade-offs regarding how best to classify respondents identifying with the SE and DK categories. OBJECTIVES: Develop respondent-level probabilities of sexual minority orientation without excluding or misclassifying the potentially ambiguous SE and DK responses. Compare 3 increasingly inclusive analytic approaches for estimating health disparities using a single item: (a) omitting SE and DK respondents; (b) classifying SE as sexual minority and omitting DK; and (c) a new approach classifying only SE and DK respondents with >50% predicted probabilities of being sexual minorities as sexual minority. MATERIALS AND METHODS: We used the sociodemographic information and follow-up questions for SE and DK respondents in the 2013-2014 National Health Interview Survey to generate predicted probabilities of identifying as a sexual minority adult. RESULTS: About 94% of the 144 SE respondents and 20% of the 310 DK respondents were predicted to identify as a sexual minority adult, with higher probabilities for younger, wealthier, non-Hispanic white, and urban-dwelling respondents. Using a more specific definition of sexual minority orientation improved the precision of health and health care disparity estimates. CONCLUSIONS: Predicted probabilities of sexual minority orientation may be used in this and other surveys to improve representation and categorization of those who identify as a sexual minority adult.

Recent advances in computing, rendering, and display technologies have generated increased accessibility for virtual reality (VR). VR allows the creation of dynamic, high-fidelity environments to simulate dangerous situations, test conditions, and visualize concepts. Consequently, numerous products have been developed, but many of these are limited in scope. Therefore, the National Institute for Occupational Safety and Health researchers developed a VR framework, called VR Mine, to rapidly create an underground mine for human data collection, simulation, visualization, and training. This paper describes the features of VR Mine using self-escape and proximity detection as case studies. Features include mine generation, simulated networks, proximity detection systems, and the integration and visualization of real-time ventilation models.

Background: Physical inactivity is a public health concern in the US Virgin Islands (USVI). A contributing factor may be a lack of pedestrian infrastructure and other environmental supports for walking. In this manuscript, we describe the methods used to conduct a walkability audit of environmental features related to physical activity in the USVI. Methods: In 2016, volunteer auditors conducted the audit using a modified version of the Microscale Audit of Pedestrian Streetscapes tool. A two-stage sampling method was developed using publicly available census data to select a sample of estates (n=46) and street segments (n=1550; 99.2 km) across the USVI. A subset of segments was audited by two independent auditors, and inter-rater reliability was assessed using Cohen's kappa and percent agreement. Results: Audits were completed on 1114 segments (94.6 km), and estimates were weighted to represent accessible public street length in the study area (1155.9 km). Most items on the audit tool (62.7%) demonstrated good to excellent reliability. We found that it was feasible to conduct a reliable audit of environmental features related to physical activity across a large sample of streets in the USVI. Conclusions: These methods can be replicated in other settings to collect comprehensive data that can be used to guide strategies to improve the walkability of communities.

Hua Brian L, Bell George W, Kashevsky Helena, Von Stetina Jessica R, Orr-Weaver Terry L. BMC genomics 2018 Aug 19(1) 623

OBJECTIVES: To determine the prevalence of community and street-scale design features that promote walking across the US Virgin Islands (USVI). METHODS: In May 2016, the USVI Department of Health, with technical assistance from the Centers for Disease Control and Prevention, conducted a territory-wide audit with a validated tool. We selected street segments (n = 1114) via a 2-stage sampling method, and estimates were weighted to be representative of publicly accessible street length. RESULTS: Overall, 10.7% of the street length contained a transit stop, 11.3% had sidewalks, 21.7% had at least 1 destination (e.g., stores, restaurants), 27.4% had a traffic calming feature (e.g., speed humps), and 53.2% had at least some street lighting. Several features were less prevalent on residential streets compared with commercial streets, including transit stops, sidewalks, destinations, and street lighting (P < .01). CONCLUSIONS: Across the USVI, community and street-scale features supportive of walking were uncommon. Improving community and street-scale design in the USVI, particularly in residential areas, could increase physical activity by enhancing walkability and therefore improve public health. These data can be used to inform community planning in the USVI. (Am J Public Health. Published online ahead of print June 21, 2018: e1-e4. doi:10.2105/AJPH.2018.304449).

BACKGROUND: Carbon monoxide (CO) is an insidious gas responsible for approximately 21,000 emergency department visits, 2300 hospitalizations, and 500 deaths in the United States annually. We analyzed 10 combined years of data from two Agency for Toxic Substances and Disease Registry acute hazardous substance release surveillance programs to evaluate CO incident-related injuries. METHODS: Seventeen states participated in these programs during 2005-2014. RESULTS: In those 10years, the states identified 1795 CO incidents. Our analysis focused on 897 CO incidents having injured persons. Of the 3414 CO injured people, 61.0% were classified as general public, 27.7% were employees, 7.6% were students, and 2.2% were first responders. More than 78% of CO injured people required hospital or pre-hospital treatment and 4.3% died. The location for most injured people (39.9%) were homes or apartments, followed by educational facilities (10.0%). Educational services had a high number of people injured per incident (16.3%). The three most common sources of CO were heating, ventilation, and air conditioning systems; generators; and motor vehicles. Equipment failure was the primary contributing factor for most CO incidents. CONCLUSIONS: States have used the data to evaluate trends in CO poisoning and develop targeted public health outreach. Surveillance data are useful for setting new policies or supporting existing policy such as making CO poisoning a reportable condition at the state level and requiring CO alarms in all schools and housing. Public health needs to remain vigilant to the sources and causes of CO to help reduce this injury and death.

Children are considered to be a vulnerabletion when it comes to exposures to hazardous substances. Schools, where children spend about one third of their day, are expected to be a safe environment. Yet, there are many hazardous substances in schools that can be inadvertently or intentionally released and harm the health of students and teachers alike. The purpose of this analysis is to characterize acute chemical release incidents in school settings and identify prevention practices. The acute chemical incident surveillance programs of the Agency for Toxic Substances and Disease Registry (ATSDR) captured 24,748 acute chemical release incidents from 14 states that participated during 2008-2013. We examined 335 of these incidents that occurred at schools. While only 1.3% (n = 335) of all chemical incidents reported to ATSDR occurred in schools, these incidents represented a larger part of the total impacts, including 8.5% of incidents with persons injured, 5.7% of evacuations ordered, and 31.1% of people evacuated. Natural gas (21.8%) and mercury (18.2%) were the chemicals most frequently released. Collecting and analyzing data on acute school chemical releases allows stakeholders to target prevention initiatives and provide a school environment safe from these chemical exposures.

IntroductionFirst responders, including firefighters, police officers, emergency medical services, and company emergency response team members, have dangerous jobs that can bring them in contact with hazardous chemicals among other dangers. Limited information is available on responder injuries that occur during hazardous chemical incidents. METHODS: We analyzed 2002-2012 data on acute chemical incidents with injured responders from 2 Agency for Toxic Substances and Disease Registry chemical incident surveillance programs. To learn more about such injuries, we performed descriptive analysis and looked for trends. RESULTS: The percentage of responders among all injured people in chemical incidents has not changed over the years. Firefighters were the most frequently injured group of responders, followed by police officers. Respiratory system problems were the most often reported injury, and the respiratory irritants, ammonia, methamphetamine-related chemicals, and carbon monoxide were the chemicals more often associated with injuries. Most of the incidents with responder injuries were caused by human error or equipment failure. Firefighters wore personal protective equipment (PPE) most frequently and police officers did so rarely. Police officers' injuries were mostly associated with exposure to ammonia and methamphetamine-related chemicals. Most responders did not receive basic awareness-level hazardous material training. CONCLUSION: All responders should have at least basic awareness-level hazardous material training to recognize and avoid exposure. Research on improving firefighter PPE should continue. (Disaster Med Public Health Preparedness. 2018;12:211-221).

A standardized method to reduce analytic variables for the collection of human tissue is essential for investigators seeking to advance findings from basic disease research to new therapies for patients. When designing experiments involving human tissue samples, researchers must define specific donor criteria and preservation requirements useful for their analysis. Access to tissue from donors who fit specific criteria can be problematic if the donor profile or disease is not widespread. The biggest challenge facing human tissue research is identifying a significant number of donors who match specific eligibility criteria to add value to studies seeking cures or treatments for devastating diseases. Both diseased and nondiseased tissues are needed for comparison to understand the mechanisms of dysfunction, to seek potential biomarkers, or to evaluate potential therapies for disorders. The key to mitigating the challenge facing human tissue research is establishing a wide donor screening and recovery network to maximize donation opportunities that meet donor eligibility requirements and tissue collection parameters. The National Disease Research Interchange (NDRI) has developed several novel approaches to serve these specific scientific needs. To support uniform human tissue collection programs, NDRI has become accredited by the College of American Pathologists as a biorepository to enhance the reproducibility of our recovery network. | One method that NDRI uses to capture these very important human biospecimens is partnerships with organ procurement organizations (OPOs) for the screening and recovery of donors throughout the United States. The landscape of organ and tissue donation for transplant has changed significantly in the past 35 years, which has led to great opportunities for human tissue research efforts. Following the National Organ and Transplant Act passed by Congress in 1984, the Organ Procurement Transplantation Network was established to manage the organ matching process at 58 OPOs throughout the country. Currently, about 1.4 million deaths that occur in acute clinical care settings in the United States are referred to these OPOs for consideration for transplant. As not all organs and tissues from these donors are eligible for transplant, there are opportunities for donation of tissue for research through the same mechanism. The NDRI, a 501(c)3 not-for-profit, uses the extensive screening and authorization in place at the OPOs to provide high-quality, highly annotated, nondiseased, and diseased tissues for research.