Development of broad-spectrum antiviral therapies is critical for outbreak and pandemic preparedness against emerging and reemerging viruses. Viruses inducing hemorrhagic fevers cause high morbidity and mortality in humans and are associated with several recent international outbreaks, but approved therapies for treating most of these pathogens are lacking. Here, we show that 4'-fluorouridine (4'-FlU; EIDD-2749), an orally available ribonucleoside analog, has antiviral activity against multiple hemorrhagic fever viruses in cell culture, including Nipah virus, Crimean-Congo hemorrhagic fever virus, orthohantaviruses, and arenaviruses. We performed preclinical in vivo evaluation of oral 4'-FlU against two arenaviruses, Old World Lassa virus (LASV) and New World Junín virus (JUNV), in guinea pig models of lethal disease. 4'-FlU demonstrated both advantageous pharmacokinetic characteristics and high efficacy in both of these lethal disease guinea pig models. Additional experiments supported protection of the infected animals even when 4'-FlU delivery was reduced to a low dose of 0.5 milligram per kilogram. To demonstrate clinical utility, 4'-FlU treatment was evaluated when initiated late in the course of infection (12 or 9 days after infection for LASV and JUNV, respectively). Delayed treatment resulted in rapid resolution of clinical signs, demonstrating an extended window for therapeutic intervention. These data support the use of 4'-FlU as a potent and efficacious treatment against highly pathogenic arenaviruses of public health concern with a virus inhibition profile suggesting broad-spectrum utility as an orally available antiviral drug against a wide variety of viral pathogens.

INTRODUCTION: After SARS-CoV-2 infection, some people will experience long-term sequelae known as post-COVID-19 condition (PCC). Although PCC is recognized as a public health problem, estimates of the prevalence of PCC are sparse. We described a framework for estimating the incidence and prevalence of PCC by population subgroups and geography over time in Washington State. METHODS: We collected data on reported COVID-19 cases and hospitalizations and estimated SARS-CoV-2 infections in Washington State from March 2020 through October 2023. The reported case data were incorporated with parameter estimates from published articles and prevalence estimates from the Household Pulse Survey into a mathematical compartmental model of PCC progression. The model used differential equations to describe how the population of people with PCC moved through the model's various stages. This framework allowed us to integrate data on age group, sex, race and ethnicity, vaccination status, and county to estimate incidence and prevalence of PCC for each subgroup. RESULTS: Our model indicated that 6.4% (95% CI, 5.9%-6.8%) of all adults in Washington State were experiencing PCC as of October 2023. In addition to temporal differences in PCC prevalence and incidence, we found substantial differences across age groups, race and ethnicity, and sex. Geographic heterogeneity was pronounced, with the highest rates of PCC in central and eastern Washington. CONCLUSION: Estimation of PCC prevalence is essential for addressing PCC as a public health problem. Responding to PCC will require continued surveillance, research, and dedicated financial and public health action. This analysis, accounting for heterogeneities, highlights disparities in the prevalence, incidence, and distribution of PCC in Washington State and can better guide awareness and response efforts.

Volcanoes―active, dormant, and extinct―are found on every continent on Earth. Many lay submerged below the oceans, and others exist as islands. Volcanic explosions, upheavals, and lava flows, coupled with eons of weathering, have formed mountains and plateaus, created craters, and etched valleys. Approximately 80 percent of Earth’s surface was created by volcanic activity. The United States Geological Survey notes, “Gaseous emissions from volcanic vents over hundreds of millions of years formed the Earth’s earliest oceans and atmosphere, which supplied the ingredients vital to evolve and sustain life.” | | Ancient to modern eyewitness accounts document the devastation and spectacle associated with volcanic eruptions. For centuries, artists have depicted in their works both the sublime beauty and unthinkable destruction of volcanic eruptions. Among them is the Norwegian painter Johan Christian Claussen Dahl. Considered the first great Romantic painter in Norway and among the greatest European artists of all time, Dahl traveled to Italy during the fall of 1820. He visited Naples in late December of that year and observed firsthand Vesuvius erupting, an event he called an “interesting and horribly wondrous sight.” This month’s cover image, Eruption of the Volcano Vesuvius, 1821, is the first in a series of paintings he created after that experience.

Girolamo Francesco Maria Mazzola (1503–1540), known as Parmigianino (the little one from Parma), was a painter and printmaker. He was born into a family of painters in Parma, in what was then the Duchy of Milan, and died in Cremona, in northern Italy. He was among the first and most prominent artists of the Mannerist school of art of the Late Renaissance that came after the High Renaissance. The High Renaissance is known for the works of Raphael and the early works of Michelangelo, and its art is treasured for perfection of elegance and qualities of balance, proportion, and absoluast, in Mannerism, compositions are said to be exaggerated, almost to a fault, as a reaction to the art of the High Renaissance or perhaps as an attempt to improve on it. In general, it is characterized by realist but decorous art in which there is subtle, unsettling elongation of figures with stylized features and poses. | | Among Parmigianino’s more renowned works is a portrait painting from 1531‒1534 of a young woman, Antea, which appears on the cover of this month’s journal. It is unknown if the painting is an image of a specific person or a stylized composition. We behold a beautiful young woman facing forward, with elongated bodily proportions, as is characteristic of Mannerist works. With a small oval head set upon a large torso and with wide shoulders, her arms and hands appear exaggerated in size, as if the parts of her body were proportioned for different paintings. Yet despite these physical disproportions, the viewer has an impression of great beauty, a testimony to the subtlety and success of this Mannerist portrait. Contributing to the incongruousness of the image of this young lady, we also note that she is clad in the garments of an older woman, or a woman of an age with which we more commonly associate wealth; Antea is bejeweled, fingering a gold chain with her left hand, and dressed luxuriously. Among her layers of garments are a gold blouse with a fine white apron, a detailed gold satin dress, leather gloves, and a marten fur stole complete with the animal’s head, on which the nose is pierced with a ring still attached to a chain.

Coronaviruses (CoVs) traffic frequently between species resulting in novel disease outbreaks, most recently exemplified by the newly emerged SARS-CoV-2. Herein, we show that the ribonucleoside analog β-D-N4-hydroxycytidine (NHC, EIDD-1931) has broad spectrum antiviral activity against SARS-CoV 2, MERS-CoV, SARS-CoV, and related zoonotic group 2b or 2c Bat-CoVs, as well as increased potency against a coronavirus bearing resistance mutations to another nucleoside analog inhibitor. In mice infected with SARS-CoV or MERS-CoV, both prophylactic and therapeutic administration of EIDD-2801, an orally bioavailable NHC-prodrug (b-D-N4-hydroxycytidine-5’-isopropyl ester), improved pulmonary function, and reduced virus titer and body weight loss. Decreased MERS-CoV yields in vitro and in vivo were associated with increased transition mutation frequency in viral but not host cell RNA, supporting a mechanism of lethal mutagenesis. The potency of NHC/EIDD-2801 against multiple coronaviruses, its therapeutic efficacy, and oral bioavailability in vivo, all highlight its potential utility as an effective antiviral against SARS-CoV-2 and other future zoonotic coronaviruses.

BACKGROUND: Men who have sex with men (MSM) accounted for two thirds of new HIV infections in the United States in 2019 despite representing approximately 2% of the adult population. METHODS: CDC analyzed surveillance data to determine trends in estimated new HIV infections and to assess measures of undiagnosed infection and HIV prevention and treatment services including HIV testing, preexposure prophylaxis (PrEP) use, antiretroviral therapy (ART) adherence, and viral suppression, as well as HIV-related stigma. RESULTS: The estimated number of new HIV infections among MSM was 25,100 in 2010 and 23,100 in 2019. New infections decreased significantly among White MSM but did not decrease among Black or African American (Black) MSM and Hispanic/Latino MSM. New infections increased among MSM aged 25-34 years. During 2019, approximately 83% of Black MSM and 80% of Hispanic/Latino MSM compared with 90% of White MSM with HIV had received an HIV diagnosis. The lowest percentage of diagnosed infection was among MSM aged 13-24 years (55%). Among MSM with a likely PrEP indication, discussions about PrEP with a provider and PrEP use were lower among Black MSM (47% and 27%, respectively) and Hispanic/Latino MSM (45% and 31%) than among White MSM (59% and 42%). Among MSM with an HIV diagnosis, adherence to ART and viral suppression were lower among Black MSM (48% and 62%, respectively) and Hispanic/Latino MSM (59% and 67%) compared with White MSM (64% and 74%). Experiences of HIV-related stigma among those with an HIV diagnosis were higher among Black MSM (median = 33; scale = 0-100) and Hispanic/Latino MSM (32) compared with White MSM (26). MSM aged 18-24 years had the lowest adherence to ART (45%) and the highest median stigma score (39). CONCLUSION: Improving access to and use of HIV services for MSM, especially Black MSM, Hispanic/Latino MSM, and younger MSM, and addressing social determinants of health, such as HIV-related stigma, that contribute to unequal outcomes will be essential to end the HIV epidemic in the United States.

In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel(†) and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities(§) initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3).

Charles Laval (1861–1894) was a Parisian painter whose brief life ended in an untimely death from underlying tuberculosis. He was a colleague and contemporary of two other post-Impressionists: Vincent van Gogh (1853–1890) and Paul Gauguin (1848–1903). In part because of misattribution, Laval’s work has receded into a historical footnote to the career of Gauguin, whose output far exceeded that of Laval. Gauguin, among the most renowned of the late 19th century European artists, was a pioneer of the Synthetist school of painting. This post-Impressionist movement encouraged artists to depict their emotions about the subject, beyond its outward appearance, with bold displays of color, relaxation of exactitude, and portrayal of form based on memory. | | Laval studied under realist painter Léon Bonnat at the École des Beaux-Arts in Paris. In the summer of 1886, he became acquainted with van Gogh and Gauguin at Pont-Aven, a growing artist colony in Brittany. In April 1887, Laval and Gauguin set sail for Panama, an adventure that was ostensibly pursued for employment at the invitation of Gauguin’s brother-in-law, a Chilean with business interests in Panama. In June 1887, after several misadventures, Laval and Gauguin left Panama for Martinique, where they painted together before returning to France in November of the same year.

Coronaviruses (CoVs) traffic frequently between species resulting in novel disease outbreaks, most recently exemplified by the newly emerged SARS-CoV-2, the causative agent of COVID-19. Herein, we show that the ribonucleoside analog beta-D-N(4)-hydroxycytidine (NHC, EIDD-1931) has broad spectrum antiviral activity against SARS-CoV-2, MERS-CoV, SARS-CoV, and related zoonotic group 2b or 2c Bat-CoVs, as well as increased potency against a coronavirus bearing resistance mutations to the nucleoside analog inhibitor remdesivir. In mice infected with SARS-CoV or MERS-CoV, both prophylactic and therapeutic administration of EIDD-2801, an orally bioavailable NHC-prodrug (beta-D-N(4)-hydroxycytidine-5'-isopropyl ester), improved pulmonary function, and reduced virus titer and body weight loss. Decreased MERS-CoV yields in vitro and in vivo were associated with increased transition mutation frequency in viral but not host cell RNA, supporting a mechanism of lethal mutagenesis in CoV. The potency of NHC/EIDD-2801 against multiple coronaviruses and oral bioavailability highlight its potential utility as an effective antiviral against SARS-CoV-2 and other future zoonotic coronaviruses.

Routine incident malaria case data have become a pillar of malaria surveillance in sub-Saharan Africa. These data provide granular, timely information to track malaria burden. However, incidence data are sensitive to changes in care seeking rates, rates of testing of suspect cases, and reporting completeness. Based on a set of assumptions, we derived a simple algebraic formula to convert crude incidence rates to a corrected estimation of incidence, adjusting for biases in variable and suboptimal rates of care seeking, testing of suspect cases, and reporting completeness. We applied the correction to routine incidence data from Guinea and Mozambique, and aggregate data for sub-Saharan African countries from the World Malaria Report. We calculated continent-wide needs for malaria tests and treatments, assuming universal testing but current care seeking rates. Countries in southern and eastern Africa reporting recent increases in malaria incidence generally had lower overall corrected incidence than countries in Central and West Africa. Under current care seeking rates, the unmet need for malaria tests was estimated to be 160 million (M) (interquartile range [IQR]: 139-188) and for malaria treatments to be 37 M (IQR: 29-51). Maps of corrected incidence were more consistent with maps of community survey prevalence than was crude incidence in Guinea and Mozambique. Crude malaria incidence rates need to be interpreted in the context of suboptimal testing and care seeking rates, which vary over space and time. Adjusting for these factors can provide an insight into the spatiotemporal trends of malaria burden.

Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.

A century ago, the world was ensnared in the Great War, 1914–1918, now known as the First World War. During that war, an estimated 9 million combatants and as many as 7 million civilians died, and it brought to an end the German, Russian, Austro-Hungarian, and Ottoman Empires. Infectious diseases played a prominent role in that war, resulting in more casualties than did war-inflicted wounds. With several decades of knowledge about bacterial organisms, armies had implemented sanitation measures such as latrines and water purification methods to control diarrheal and dysenteric diseases. Vaccine successes had been documented for smallpox and typhoid. However, louse-borne typhus killed 2–3 million soldiers and civilians on the Eastern Front, and the war’s end in November 1918 was hastened by an influenza pandemic that had begun in January 1918 and eventually claimed the lives of an estimated 50 million. | | Because of the huge numbers of casualties, control of media was important for maintaining positive public opinion and support for the war efforts; all combatant countries developed central censorship and propaganda offices. The United States entered the war in April 1917, fully two-and-a-half years into the conflict, and created its own Committee on Public Information and its own Censorship Board. For the Austro-Hungarian forces, the central censorship and propaganda institution was the War Press Office, or Kriegspressequartier, which eventually included more than 750 writers, journalists, photographers, and filmmakers, and some 150 visual artists. Painters and photographers worked in the field of combat, many as military officers, and sketched quick impressions, which they could later render more elaborate or refined, when they were away from the dangers of the front. Among these many painters was a young artist, Ernst Liebenauer (1884–1970), who had studied under reknowned realist Christian Griepenkerl at the Wiener Akademie der Bildenden Künste (Viennese Academy of Fine Arts) and later at the Spezialschule für Historienmalerei (Special School for Historical Painting) under another well-known Austrian portrait and landscape painter, Franz Rumpler. During the war, Liebenauer focused on military subjects, but after the war, he became a painter of landscapes, still life, portraits, and mythical scenes. He was best known as an illustrator of children’s books and fairy tales, including versions of Daniel Defoe’s Robinson Crusoe and the works of the Brothers Grimm.

OBJECTIVE:: The Care and Prevention in the United States (CAPUS) Demonstration Project was a 4-year (2012-2016) cross-agency demonstration project that aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states (Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, and Virginia). Its goals were to increase the identification of undiagnosed HIV infections and optimize the linkage to, reengagement with, and retention in care and prevention services for people with HIV (PWH). We present descriptive findings to answer selected cross-site process and short-term outcome monitoring and evaluation questions. METHODS:: We answered a set of monitoring and evaluation questions by using data submitted by grantees. We used a descriptive qualitative method to identify key themes of activities implemented and summarized quantitative data to describe program outputs and outcomes. RESULTS:: Of 155 343 total HIV tests conducted by all grantees, 558 (0.36%) tests identified people with newly diagnosed HIV infection. Of 4952 PWH who were presumptively not in care, 1811 (36.6%) were confirmed as not in care through Data to Care programs. Navigation and other linkage, retention, and reengagement programs reached 10 382 people and linked to or reengaged with care 5425 of 7017 (77.3%) PWH who were never in care or who had dropped out of care. Programs offered capacity-building trainings to providers to improve cultural competency, developed social marketing and social media campaigns to destigmatize HIV testing and care, and expanded access to support services, such as transitional housing and vocational training. CONCLUSIONS:: CAPUS grantees substantially expanded their capacity to deliver HIV-related services and reach racial/ethnic minority groups at risk for or living with HIV infection. Our findings demonstrate the feasibility of implementing novel and integrated programs that address social and structural barriers to HIV care and prevention.

Major advances have been made in reducing HIV-related morbidity and mortality since the first infections were reported in the United States more than 36 years ago.1,2 However, racial/ethnic minority populations are disproportionately affected.3,4 The Care and Prevention in the United States (CAPUS) Demonstration Project (hereinafter, CAPUS; 2012-2016) aimed to reduce HIV-related morbidity, mortality, and health disparities among these priority populations in 8 states: Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, and Virginia.5 State health departments collectively received $42.8 million through the US Department of Health and Human Services Secretary’s Minority AIDS Initiative Fund6 to expand and improve HIV testing capacity and optimize linkage to, retention in, and reengagement with care and prevention services for people with HIV (PWH).5 Eligibility for funding was based on the high HIV disease burden among racial/ethnic minority populations, the disproportionate rate of AIDS diagnoses and associated mortality, and the pervasive effect of social and structural determinants of health within a jurisdiction.

Universal malaria diagnostic testing of all fever cases is the first step in correct malaria case management. However, monitoring adherence to universal testing is complicated by unreliable recording and reporting of the true number of fever cases. We searched the literature to obtain gold-standard estimates for the proportion of patients attending outpatient clinics in sub-Saharan Africa with malarial and non-malarial febrile illness. To correct for differences in malaria transmission, we calculated the proportion of patients with fever after excluding confirmed malaria cases. Next, we analyzed routine data from Guinea and Senegal to calculate the proportion of outpatients tested after exclusion of confirmed malaria cases from the numerator and denominator. From 12 health facility surveys in sub-Saharan Africa with gold-standard fever screening, the median proportion of febrile illness among outpatients after exclusion of confirmed malaria fevers was 57% (range: 46-80%). Analysis of routine data after exclusion of confirmed malaria cases demonstrated much lower testing proportions of 23% (Guinea) and 13% (Senegal). There was substantial spatial and temporal heterogeneity in this testing proportion, and testing in Senegal was correlated with malaria season. Given the evidence from gold-standard surveys that at least 50% of non-malaria consultations in sub-Saharan Africa are for febrile illness, it appears that a substantial proportion of patients with fever are not tested for malaria in health facilities when considering routine data. Tracking the proportion of patients tested for malaria after exclusion of the confirmed malaria cases could allow programs to make inferences about malaria testing practices using routine data.

Sylvatic plague poses a substantial risk to black-tailed prairie dogs ( Cynomys ludovicianus) and their obligate predator, the black-footed ferret ( Mustela nigripes). The effects of plague on prairie dogs and ferrets are mitigated using a deltamethrin pulicide dust that reduces the spread of plague by killing fleas, the vector for the plague bacterium. In portions of Conata Basin, Buffalo Gap National Grasslands, and Badlands National Park, South Dakota, 0.05% deltamethrin has been infused into prairie dog burrows on an annual basis since 2005. We aimed to determine if fleas ( Oropsylla hirsuta) in portions of the Conata Basin and Badlands National Park have evolved resistance to deltamethrin. We assessed flea prevalence, obtained by combing prairie dogs for fleas, as an indirect measure of resistance. Dusting was ineffective in two colonies treated with deltamethrin for >8 yr; flea prevalence rebounded within 1 mo of dusting. We used a bioassay that exposed fleas to deltamethrin to directly evaluate resistance. Fleas from colonies with >8 yr of exposure to deltamethrin exhibited survival rates that were 15% to 83% higher than fleas from sites that had never been dusted. All fleas were paralyzed or dead after 55 min. After removal from deltamethrin, 30% of fleas from the dusted colonies recovered, compared with 1% of fleas from the not-dusted sites. Thus, deltamethrin paralyzed fleas from colonies with long-term exposure to deltamethrin, but a substantial number of those fleas was resistant and recovered. Flea collections from live-trapped prairie dogs in Thunder Basin National Grasslands, Wyoming suggest that, in some cases, fleas might begin to develop a moderate level of resistance to deltamethrin after 5-6 yr of annual treatments. Restoration of black-footed ferrets and prairie dogs will rely on an adaptive, integrative approach to plague management, for instance involving the use of vaccines and rotating applications of insecticidal products with different active ingredients.

Hispanic/Latino migrants and immigrants are vulnerable to infection by HIV and other sexually transmitted diseases (STDs). Participation in social support networks helps them cope with circumstances in the U.S. Studies of Hispanic/Latino migrants suggest that participation may also be protective against HIV/STD infection. However the studies do not satisfactorily explain how participation leads to protective actions, and recommend externally-induced interventions for HIV/STD prevention rather than incorporating the spontaneously occurring forms of social support they describe. Given the potential protective effects of support networks, a database search was conducted to ascertain the extent to which published HIV/STD prevention interventions for these populations incorporate their support networks. Very few interventions were identified and fewer still incorporate support networks. This commentary calls for research to understand more fully how support networks affect HIV/STD risks among Hispanic/Latino migrants and immigrants and identifies potential benefits of incorporating these networks in HIV/STD prevention for these vulnerable populations.

SETTING: In 2007, the US Centers for Disease Control and Prevention (CDC) revised its tuberculosis (TB) technical instructions for panel physicians who administer mandatory medical examinations among US-bound immigrants. Many US-bound immigrants come from the Philippines, a high TB prevalence country. OBJECTIVE: To quantify economic and health impacts of smear- vs. culture-based TB screening. DESIGN: Decision tree modeling was used to compare three Filipino screening programs: 1) no screening, 2) smear-based screening, and 3) culture-based screening. The model incorporated pre-departure TB screening results from Filipino panel physicians and CDC databases with post-arrival follow-up outcomes. Costs (2013 $US) were examined from societal, immigrant, US Public Health Department and hospitalization perspectives. RESULTS: With no screening, an annual cohort of 35 722 Filipino immigrants would include an estimated 450 TB patients with 264 hospitalizations, at a societal cost of US$9.90 million. Culture-based vs. smear-based screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs (US$1.57 million vs. US$4.28 million). Societal screening costs, including US follow-up, were greater for culture-based screening (US$5.98 million) than for smear-based screening (US$3.38 million). Culture-based screening requirements increased immigrant costs by 61% (US$1.7 million), but reduced costs for the US Public Health Department (22%, US$750 000) and of hospitalization (70%, US$1 020 000). CONCLUSION: Culture-based screening reduced imported TB and US costs among Filipino immigrants.

CONTEXT: Obesity is a significant health issue in the United States that both clinical and public health systems struggle to address. Electronic health record data could help support multi-sectoral interventions to address obesity. Standards have been identified and created to support the electronic exchange of weight-related data across many stakeholder groups. CASE DESCRIPTION: The Centers for Disease Control and Prevention initiated a public-private partnership including government, industry, and academic technology partners to develop workflow scenarios and supporting systems to exchange weight-related data through standard transactions. This partnership tested the transmission of data using this newly-defined Healthy Weight (HW) profile at multiple health data interoperability demonstration events. FINDINGS: Five transaction types were tested by 12 partners who demonstrated how the standards and related systems support end-to-end workflows around managing weight-related issues in the community. The standard transactions were successfully tested at two Integrating the Healthcare Enterprise (IHE) Connectathon events through 86 validated tests encompassing 38 multi-partner transactions. DISCUSSION: We have successfully demonstrated the transactions defined in the HW profile with a public-private partnership. These tested IT products and HW standards could be used to support a continuum of care around health related issues encompassing both health care and public health functions. CONCLUSION: The use of the HW profile, including a set of transactions and identified standards to implement those transactions, in IT products is a helpful first step in leveraging health information technology to address weight-related issues in the United States. Future work is needed to expand the use of these standards and to assess their use in real world settings.

OBJECTIVES: To evaluate the HOLA en Grupos intervention, a Spanish-language small-group behavioral HIV prevention intervention designed to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men. METHODS: In 2012 to 2015, we recruited and randomized 304 Hispanic/Latino men who have sex with men, aged 18 to 55 years in North Carolina, to the 4-session HOLA en Grupos intervention or an attention-equivalent general health education comparison intervention. Participants completed structured assessments at baseline and 6-month follow-up. Follow-up retention was 100%. RESULTS: At follow-up, relative to comparison participants, HOLA en Grupos participants reported increased consistent condom use during the past 3 months (adjusted odds ratio [AOR] = 4.1; 95% confidence interval [CI] = 2.2, 7.9; P < .001) and HIV testing during the past 6 months (AOR = 13.8; 95% CI = 7.6, 25.3; P < .001). HOLA en Grupos participants also reported increased knowledge of HIV (P < .001) and sexually transmitted infections (P < .001); condom use skills (P < .001), self-efficacy (P < .001), expectancies (P < .001), and intentions (P < .001); sexual communication skills (P < .01); and decreased fatalism (P < .001). CONCLUSIONS: The HOLA en Grupos intervention is efficacious for reducing HIV risk behaviors among Hispanic/Latino men who have sex with men. (Am J Public Health. Published online ahead of print April 20, 2017: e1-e8. doi:10.2105/AJPH.2017.303814).

Objective. Tuberculosis control in foreign-born populations is a major public health concern for Australia, Canada, New Zealand, United Kingdom, and the United States, large immigrant- and refugee-receiving countries that comprise the Immigration and Refugee Health Working Group (IRHWG). Identifying and comparing immigration and distribution of foreign-born tuberculosis cases are important for developing targeted and collaborative interventions. Methods. Data stratified by year and country of birth from 2005 to 2009 were received from these five countries. Immigration totals, tuberculosis case totals, and multidrug-resistant tuberculosis (MDR TB) case totals from source countries were analyzed and compared to reveal similarities and differences for each member of the group. Results. Between 2005 and 2009, there were a combined 31,785,002 arrivals, 77,905 tuberculosis cases, and 888 MDR TB cases notified at the federal level in the IRHWG countries. India, China, Vietnam, and the Philippines accounted for 41.4% of the total foreign-born tuberculosis cases and 42.7% of the foreign-born MDR tuberculosis cases to IRHWG. Interpretation. Collaborative efforts across a small number of countries have the potential to yield sizeable gains in tuberculosis control for these large immigrant- and refugee-receiving countries.

Diabetes is associated with an increased risk for active tuberculosis (TB) disease. We conducted a case-control study and found a significant association between diabetes and TB disease among US-bound refugees. These findings underscore the value of collaborative management of both diseases.

This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community. The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools. Each funded consultancy targets a use case of near-term concern to practitioners. The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available. A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission. Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality. Meteorological subject matter experts described availability and usage of data sources representing these risk factors. Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids. Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements. Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers. Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement.

Lassa virus (LASV) and Ebola virus (EBOV) infections are important global health issues resulting in significant morbidity and mortality. While several promising drug and vaccine trials for EBOV are ongoing, options for LASV infection are currently limited to ribavirin treatment. A major factor impeding the development of antiviral compounds to treat these infections is the need to manipulate the virus under BSL-4 containment, limiting research to a few institutes worldwide. Here we describe the development of a novel LASV minigenome assay based on the ambisense LASV S segment genome, with authentic terminal untranslated regions flanking a ZsGreen (ZsG) fluorescent reporter protein and a Gaussia princeps luciferase (gLuc) reporter gene. This assay, along with a similar previously established EBOV minigenome, was optimized for high-throughput screening (HTS) of potential antiviral compounds under BSL-2 containment. In addition, we rescued a recombinant LASV expressing ZsG, which, in conjunction with a recombinant EBOV reporter virus, was used to confirm any potential antiviral hits in vitro. Combining an initial screen to identify potential antiviral compounds at BSL-2 containment before progressing to HTS with infectious virus will reduce the amount of expensive and technically challenging BSL-4 containment research. Using these assays, we identified 6-azauridine as having anti-LASV activity, and demonstrated its anti-EBOV activity in human cells. We further identified 2'-deoxy-2'-fluorocytidine as having potent anti-LASV activity, with an EC50 value 10 times lower than that of ribavirin.

Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities.

This study aimed to assess the association between giardiasis and subsequent development of arthritis or joint pain using a retrospective cohort of individuals from a large administrative claims database in the United States. Using 2006-2010 data from MarketScan Commercial Claims and Encounters, we conducted a retrospective cohort study in people with an ICD-9-CM code for giardiasis (n = 3301) and persons without giardiasis (n = 14 612) individually matched on age, sex, and enrolment length. We used conditional logistic regression to model the association between giardiasis and arthritis or joint pain documented in the 6 months following initial giardiasis diagnosis or index date for matched controls. After adjusting for healthcare utilization rate, giardiasis was associated with a 51% increase in claims for arthritis or joint pain (odds ratio 1.51, 95% confidence interval 1.26-1.80). In age- and sex-stratified adjusted analyses, the association remained significant across all subgroups (age 0-19 years, age 20-64 years, males, and females). Findings from this study lend epidemiological support for the association between giardiasis and subsequent development of arthritis. Reactive arthritis might occur more frequently than has been reported in the literature. Further research is necessary to determine the mechanisms by which giardiasis could lead to arthritis.

A novel Legionella species was identified based on sequencing, cellular fatty acid analysis, biochemical reactions, and biofilm characterization. Strain D5610 was originally isolated from the bronchial wash of a patient in Ohio. The bacteria were Gram negative, rod shaped, and exhibited a green fluorescence under long wave UV light. Phylogenetic analysis and fatty acid composition revealed a distinct separation within the genus. The strain grows between 26-45 degrees C and forms biofilms equivalent to L. pneumophila Philadelphia 1. These characterizations suggest that this isolate is a novel Legionella species for which the name Legionella clemsonensis sp nov. is proposed.

OBJECTIVE: The southeastern United States has the fastest-growing Hispanic/Latino population in the country and carries a disproportionate HIV burden. Among Hispanics/Latinos, men, and men who have sex with men (MSM) in particular, are at elevated risk of HIV infection; however, very few efficacious behavioral HIV prevention interventions are available for use with this vulnerable population. To address this shortage of prevention resources, our community-based participatory research (CBPR) partnership developed and is currently evaluating the efficacy of the HOLA en Grupos intervention to increase condom use and HIV testing among Hispanic/Latino MSM. METHODS: We recruited 304 Hispanic/Latino MSM who were randomized to receive the small group HOLA en Grupos intervention that was implemented during four 4-hour long sessions over four consecutive Sundays, or a 4-session small group general health education comparison intervention. At the end of the fourth session of the HOLA en Grupos intervention, the intervention facilitators asked participants to write down the sexual health-related behaviors they intended to change as a result of their participation. RESULTS: Qualitative analysis of the participants' responses identified six types of intended behavior changes: increasing and maintaining condom use; identifying strategies to support correct and consistent condom use; increasing communication and negotiation with sexual partners about condom use; getting tested for HIV and other sexually transmitted infections; applying other sexual health promotion strategies; and sharing newly learned sexual health information with their peers. CONCLUSION: Most risk-reduction intentions aligned with the intervention's key messages of using condoms consistently and getting tested for HIV. However, participants' stated intentions may have also depended on which behavior changes they perceived as most salient after participating in the intervention. Participants' intentions to share information with their peers may result in elements of the intervention content reaching others within their social networks, and potentially contributing to a broader community-level impact.

Cryptosporidium is the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995-2012. The Cochran-Armitage test was used to assess changes in the proportions of cases by case status (confirmed vs. non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995-2004, 2005-2008, 2009-2012). The proportion of confirmed cases significantly decreased (P < 0.0001), and a crossover from male to female predominance in case-patients occurred (P < 0.0001). Overall, compared to 1995-2004, rates were higher in 2005-2008 (RR 2.92, 95% CI 2.08-4.09) and 2009-2012 (RR 2.66, 95% CI 1.90-3.73). However, rate changes from 2005-2008 to 2009-2012 varied by age group (P interaction < 0.0001): 0-14 years (RR 0.55, 95% CI 0.42-0.71), 15-44 years (RR 0.99, 95% CI 0.82-1.19), 45-64 years (RR 1.47, 95% CI 1.21-1.79) and 65 years (RR 2.18, 95% CI 1.46-3.25). The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing of Cryptosporidium specimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States.

U.S. immigration regulations require clinical and serologic screening for syphilis for all U.S.-bound refugees 15 years of age and older. We reviewed syphilis screening results for all U.S.-bound refugees from January 1, 2009 through December 31, 2013. We calculated age-adjusted prevalence by region and nationality and assessed factors associated with syphilis seropositivity using multivariable log binomial regression models. Among 233,446 refugees, we identified 874 syphilis cases (373 cases per 100,000 refugees). The highest overall age-adjusted prevalence rates of syphilis seropositivity were observed among refugees from Africa (1340 cases per 100,000), followed by East Asia and the Pacific (397 cases per 100,000). In most regions, male sex, increasing age, and living in non-refugee camp settings were associated with syphilis seropositivity. Future analysis of test results, stage of infection, and treatment delivery overseas is warranted in order to determine the extent of transmission risk and benefits of the screening program.