Introduction: This study describes the prevalence of driving under the influence of alcohol (DUIA), marijuana (DUIM), or other illicit drugs (DUID) in the United States over time. Method: This study analyzed data from 2016–2019 National Survey on Drug Use and Health public-use files. The study sample was limited to drivers aged ≥16 years. Prevalence in 2019 and 2016–2019 trends were assessed overall, by sociodemographic characteristics, and by seatbelt use. Results: The 2019 overall prevalence of DUIA, DUIM, and DUID during the past year was 8.3%, 5.3%, and 0.9%, respectively. DUIA, DUIM, and DUID prevalence was highest for drivers who were male (10.6%, 7.0%, and 1.2%, respectively), not heterosexual (12.3%, 14.7%, and 3.5%, respectively), and did not always wear a seatbelt (12.1%, 11.5%, and 3.1%, respectively). DUIA and DUIM were highest among drivers aged 21–25 years; DUID was highest among drivers aged 21–25 or 26–34 years. From 2016 to 2019, overall DUIA decreased slightly, DUIM increased (4.5% to 5.3%), and DUID did not change; trends differed across sociodemographic groups. Conclusions: DUI is a pervasive public health issue. There are ≥10,000 DUIA crash deaths in the United States annually; proven interventions exist to prevent these deaths. Decision makers can save lives and make our roadways safer by implementing proven strategies to reduce DUIA, including lowering the legal blood alcohol concentration (BAC) for driving. Improved data and more research are needed to understand DUIM and DUID burden and determine effective prevention strategies, especially in the context of increasing DUIM. Practical Applications: There were groups for which changes in behavior patterns were found, which could guide prevention efforts. For drivers who did not always wear a seatbelt, DUIA decreased while DUIM increased. A similar pattern was noted for drivers aged 26–34 years; additionally, DUID increased in this group. © 2024

BACKGROUND: During 2017, in response to a physician's report, the Wisconsin Department of Health Services, Division of Public Health, began investigating an outbreak of febrile illness among attendees of a retreat where never frozen, intentionally undercooked, locally harvested venison was served. Preliminary testing tentatively identified the illness as toxoplasmosis. METHODS: Confirmatory human serology panels and testing of the venison to confirm and categorize the presence and type of Toxoplasma gondii were completed by French and American national reference laboratories. All 12 retreat attendees were interviewed; medical records were reviewed. RESULTS: All attendees were male; median age was 51 years (range: 22-75). After a median incubation period of 7 days, 9 (82%) of 11 exposed persons experienced illness lasting a median of 12 days. All 9 sought outpatient healthcare for symptoms including fever, chills, sweats, and headache (100%) and ocular disturbances (33%). Testing confirmed the illness as toxoplasmosis and venison as the infection source. Multiple laboratory results were atypical for toxoplasmosis, including transaminitis (86%), lymphocytopenia (88%), thrombocytopenia (38%), and leukopenia (63%). One exposed but asymptomatic person was seronegative; the other had immunity from prior infection. The T. gondii strain was identified as closely related to an atypical genotype (haplogroup 12, polymerase chain reaction restriction fragment length polymorphism genotype 5) common in North American wildlife but with previously uncharacterized human clinical manifestations. CONCLUSIONS: The T. gondii strain contaminating the venison might explain the unusual clinical presentations. In North America, clinicians and venison consumers should be aware of risk for severe or unusual presentations of acute toxoplasmosis after consuming undercooked game meat.