BACKGROUND AND OBJECTIVES: Fungal infections cause substantial morbidity and mortality. Monitoring antifungal use is a foundational aspect of antifungal stewardship, particularly as new disease-causing fungi emerge and antifungal resistance spreads. We assessed recent patterns in systemic antifungal medication use among hospitalized patients within a diverse convenience sample of academic medical centres and community hospitals in the USA. METHODS: We conducted a multicentre retrospective cohort study using the Vizient(R) Clinical Data Base. We selected hospitalized patients who received >/=1 dose of systemic antifungal medication during 2018-23 and assessed antifungal days of therapy (DOT) per 1000 patient days. We stratified antifungal DOT by National Comprehensive Cancer Network (NCCN) cancer centre status to compare antifungal use at hospitals with an NCCN-designated cancer centre-some of which also include a main academic medical centre and non-cancer service lines-versus hospitals without an NCCN-designated cancer centre. RESULTS: Among 39 956 873 discharges from 412 hospitals, the proportion of patients who received any systemic antifungal was 4.5%; azoles (3.8%) were the most common antifungal class, followed by echinocandins (0.9%). Overall antifungal DOT were 53.7 per 1000 patient days (114.5 among 25 NCCN hospitals and 43.2 among 387 non-NCCN hospitals). CONCLUSIONS: Substantial antifungal use occurs among hospitalized patients, particularly among those with cancer. The growing population susceptible to fungal infections (e.g. transplants, cancer and other immunosuppressing conditions) warrants consideration of antifungal stewardship and evaluation of appropriateness of antifungal use in the context of increasing resistance.

Colorectal cancer (CRC) screening allows for early detection and prevention through removal of polyps. In 2021, the US Preventive Services Task Force updated recommendations to screen adults aged 45 to 75 years. We analyzed 2022 Behavioral Risk Factor Surveillance System data to establish baseline prevalence estimates for those eligible for screening aged 45 to 75, including those aged 45 to 49 years who are newly eligible. Only 61.4% of adults aged 45 to 75 were up to date with CRC screening, below the Healthy People 2030 target (72.8%). Public health and clinical systems can prioritize identifying and screening adults not up to date on screening to reduce CRC risk.

BACKGROUND: The prevalence of cardiometabolic risk factors may vary by disaggregated race and ethnicity categories, and by acculturation-related factors. We evaluated the association between nativity and length of US residence, and prevalence of diabetes, hypertension, and hypercholesterolemia by select disaggregated race and ethnicity groups. METHODS: We conducted a pooled cross-sectional study of 218 158 US adults from the Medical Expenditure Panel Survey (2013-2022). Nativity (US born, non-US born) and length of US residence (>/=15 years or <15 years) were used as select proxies for acculturation. Self-reported cardiometabolic risk factors included diabetes, hypertension, and hypercholesterolemia. RESULTS: Results showed substantial heterogeneity among both aggregated and disaggregated racial and ethnic groups. Nativity (US born versus non-US born) was significantly associated with increased hypertension prevalence among Hispanic adults (odds ratio [OR], 1.26 [95% CI, 1.15-1.39]), whereas among detailed categories the OR varied from 0.68 (95% CI, 0.51-0.93) among Puerto Rican adults to 1.34 (95% CI, 1.18-1.52) among Mexican adults. For the association between length of US residence and hypercholesterolemia, the OR for all Non-Hispanic Asian adults was 1.18 (95% CI, 0.92-1.51), whereas results varied in detailed categories from 1.00 (95% CI, 0.64-1.57) among Indian adults to 1.69 (95% CI, 1.08-2.64) among Chinese adults. CONCLUSION: The association between US nativity or length of US residence and cardiometabolic risk factors varies by disaggregated race and ethnicity among Hispanic and Non-Hispanic Asian adults. Future studies may evaluate comprehensive measures of acculturation and assess other race and ethnicity groups to inform tailored efforts to improve cardiometabolic risk factor prevention and treatment.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD), a progressive lung condition, is a leading cause of disability and death. Cigarette smoking and workplace exposures are important risk factors for COPD. To examine occupations with COPD deaths among decedents with usual lifetime employment in the construction industry. METHOD: The 2021-2022 National Vital Statistics System public use multiple cause-of-death data (cross-sectional) were analysed. RESULTS: Among 6.7 million decedents, 497 031 (10.3%) were employed in the construction industry during most of their life and of those, 11.7% (n=57 937) had COPD listed on the death certificate as the underlying or contributing cause of death. The highest numbers of COPD deaths were among adults 65 years and older (n=44 550), males (n=55 092), non-Hispanic white persons (n=50 903) and persons with </=high school education (n=46 621). Construction workers had 1.31 (95% CI 1.30 to 1.32) times the odds of COPD deaths as compared with non-construction workers. Within construction occupation groups, roofers (mortality OR (MOR) 2.31, 95% CI 2.10 to 2.55) drywall installers, ceiling tile installers and tapers (MOR 2.29, 95% CI 3.05 to 2.56); painters, paperhangers, pipelayers, plasterers and stucco masons (MOR 2.09; 95% CI 1.92 to 2.28) and insulation workers (MOR 2.00, 95% CI 1.66 to 2.41) COPD mortality risk was significantly increased and the mortality odds were twice or more as compared with the reference group (office and administrative support workers). CONCLUSIONS: Disparities in COPD mortality observed among construction industry workers may be addressed by reducing COPD risk factors, including cigarette smoking and COPD-related workplace exposures, and emphasising the importance of early diagnosis and disease management.

INTRODUCTION: The purpose of this study was to evaluate the effectiveness and cost of a patient navigation (PN) program in a large federally qualified health center (FQHC). METHODS: The PN program implemented at AltaMed was evaluated; it is an FQHC that participated in the Centers for Disease Control and Prevention's Colorectal Cancer Control Program. A tailored data collection tool was developed to collect time and resources spent on program activities, salaries of staff, nonlabor resources, and process and outcome measures for 2021-2023. Sociodemographic characteristics and screening uptake for 2020-2023 was collected. Screening uptake and percentage of stool-based tests returned by year and intervention type and compared process measures was calculated, as was the cost of strategies used to increase uptake of stool-based colorectal cancer screening tests. RESULTS: The percentage of fecal immunochemical tests (FIT) returned among those receiving the PN program ranged from 36.6% in 2021 to 51.0% in 2023. The total annual cost for PN, mailings of FITs, and cost of the FIT kits ranged from $328,000 to $388,000 across the 3 years. The FQHC cost per person completing FITs decreased from $32 in 2021 to $25 in 2023. The total cost (FQHC and payer reimbursement) was calculated at $54 in 2021, $44 in 2022, and $47 in 2023 for each person completing FIT. The total cost was $512 in 2022 and $513 in 2023 per person completing Cologuard. CONCLUSION: The PN program, which used reminder texts and calls, alongside mass mailings of stool kits, increased kit returns over the implementation period.

INTRODUCTION: Significant differences exist in the risk of diabetes and diabetes-related complications by income level in the United States. We assessed 1) to what extent medical expenditures in total and by health service type differ by income levels, and 2) how demographic and socioeconomic factors and health status are associated with these differences. METHODS: Data from the 2017 through 2021 Medical Expenditure Panel Survey were analyzed to estimate annual per-person medical expenditures for adults with diabetes. These expenditures were categorized by service type (inpatient, outpatient, prescription, home health care services, emergency department, or other) and compared across income groups based on the federal poverty level (FPL): poor (<125% FPL), low (125% to <200% FPL), middle (200% to <400% FPL), and high (>/=400% FPL). One-way analysis of variance was used to test group differences, and a regression-based decomposition identified factors driving expenditure disparities. All expenditures were adjusted to 2021 US dollars. RESULTS: Mean total medical expenditures were significantly higher for the poor-income group compared with the low-income, middle-income, and high-income groups, though no significant differences were observed among the latter 3 groups. Prescription drugs and home health care services in the poor-income group accounted for most of this difference. Key factors associated with the higher expenditures in this group included elevated disability rates, poorer physical health status, and dual Medicaid-Medicare coverage. CONCLUSION: Adults with diabetes from the poorest households incurred the highest medical expenditures, largely driven by poor physical health and higher rates of disability. Reducing disability and improving health outcomes for this group may help lower their medical expenses.

SARS-CoV-2 population-based seroprevalence surveys are useful for estimating the extent of SARS-CoV-2 infections, which may be underestimated by COVID-19 case counts. Surveys conducted in October 2020 in four Nigerian states showed that SARS-CoV-2 seroprevalence ranged from 9.3% in Gombe (northeast) to 25.2% in Enugu (southeast) after the first COVID-19 wave, more than 100 and 700 times higher than the official number of COVID-19 cases in these two states, respectively. We conducted a serosurvey after the second COVID-19 wave to evaluate the extent of SARS-CoV-2 infections, attitudes to COVID-19 vaccines, and COVID-19 vaccination coverage in two regions of Nigeria. Using the World Health Organization (WHO) Unity protocol, 34 enumeration areas (EAs) each in the Federal Capital Territory (FCT) (Northcentral Zone) and Kano State (Northwest Zone) were sampled in June 2021, using probability proportional to estimated size; 20 households in one EA were randomly selected. All consenting and assenting members of a household were asked about risk behaviors; adults who were 18 years and above (the eligible population for COVID-19 vaccination in Nigeria) responded to questions on COVID-19 vaccine attitudes and receipt. Blood and nasal/oropharyngeal samples were taken from all consenting and assenting household members. Blood samples collected were tested with the Luminex xMAP(R) SARS-CoV-2 Multi-Antigen IgG Assay and swabs by reverse-transcriptase-PCR (RT-PCR). Overall response rates were 76.8% in the FCT (n = 1,505 blood draws) and 80.4% in Kano State (n = 2,178 blood draws). Following the second COVID-19 wave in Nigeria, more than 40% of residents in the FCT (40.3%, 95% CI: 34.7-45.9) and Kano State (42.6%, 95% CI: 39.4-45.8) had evidence of prior SARS-CoV-2 infection. There were no active SARS-CoV-2 infections detected by RT-PCR in either the FCT or Kano State. In the FCT and Kano State, 3.4% and 1.6% of people surveyed reported receipt of any COVID-19 vaccine, three months after vaccines were available in country. In the FCT, 77.5% of adults were aware of COVID-19 vaccines, of whom 46.9% reported willingness to receive them. In Kano State, 48.7% of adults were aware of COVID-19 vaccines, of whom 61.1% were willing to receive them. In both regions, about 84% of those reporting unwillingness to accept COVID-19 vaccines cited concerns over vaccine safety. "Serosurvey findings revealed that SARS-CoV-2 infection was far more widespread in both the Federal Capital Territory and Kano State than indicated by reported case numbers. Despite high awareness, COVID-19 vaccine uptake remained low, primarily due to concerns about vaccine safety. These results highlight the urgent need for targeted risk communication to address vaccine hesitancy and improve coverage. Serosurveys provide valuable insights that can guide public health interventions and future pandemic preparedness in Nigeria."

Studies suggest the burden of non-hospitalized severe respiratory illness might be substantial in Kenya. Using data from a Kenya COVID-19 vaccine effectiveness evaluation, we compared characteristics of patients aged ≥12 years who were hospitalized with severe respiratory illness to outpatients who were referred for hospitalization and declined (non-hospitalized). Symptom presentation and lung radiograph findings were similar among both groups, and patients in both were diagnosed with critical conditions, including acute respiratory distress syndrome (12% hospitalized; 4% non-hospitalized) and sepsis (10% both). Findings underscore the importance of including non-hospitalized severe illness when estimating the burden of disease for respiratory viruses. © 2025 Elsevier B.V., All rights reserved.

The COVID-19 pandemic has posed a significant health threat to people in corrections facilities due to communal living, inability to social distance, and high rates of comorbidity among incarcerated populations. Combined with the First Step Act of 2018, which granted incarcerated individuals seeking compassionate release access to the courts, the pandemic increased the number of people in federal prisons petitioning for early release due to health risk. Analysis of federal compassionate release case law throughout the pandemic reveals inconsistent judicial reasoning related to COVID-19-based requests. Inconsistently interpreted compassionate release factors include vaccination status, COVID-19 reinfection, and the "degree" of extraordinary circumstances considered. Varied application among federal districts produced inequitable access to compassionate release. Therefore, this analysis provides insight into how an unclear policy can create disparate public health outcomes and considerations for compassionate release determinations in future times of uncertainty, such as a pandemic.

Background: In August 2023, the Centers for Disease Control and Prevention recommended nirsevimab, a long-acting monoclonal antibody, for all U.S. infants aged <8 months entering or born during their first respiratory syncytial virus (RSV) season. Our aim was to estimate nirsevimab effectiveness against RSV-associated emergency department (ED) encounters and hospitalisation among U.S. infants during the 2023–2024 RSV season. Methods: We conducted a test-negative analysis using electronic health record (EHR) data from 6 healthcare systems, including ED encounters and hospitalizations with a diagnosis of RSV-like illness (RLI) during October 8, 2023–March 31, 2024, among infants aged <8 months as of October 1, 2023, or born during the study period. Nirsevimab effectiveness was estimated by comparing children who received nirsevimab with those who did not among RSV-positive and RSV-negative encounters, adjusting for age, race and ethnicity, sex, calendar day, and geographic region and excluding infants whose mother received RSV vaccination during pregnancy. Findings: Among 5039 ED encounters with RLI among infants in their first RSV season, 2045 (41%) were RSV-positive and 446 (9%) received nirsevimab, with a median time since dose of 52 days (interquartile range [IQR]: 27–84 days). Among 1025 hospitalizations with RLI among infants in their first RSV season, 605 (59%) were RSV-positive and 95 (9%) received nirsevimab, with a median time since dose of 48 days (IQR: 24–82 days). Nirsevimab effectiveness was 77% (95% CI: 69%–83%) against RSV-associated ED encounters and 98% (95% CI: 95%–99%) against RSV-associated hospitalisation. Interpretation: Nirsevimab was effective in preventing RSV-associated ED encounters and hospitalisation among infants in their first RSV season, with greatest protection against hospitalisation. However, these estimates reflect a short interval from nirsevimab administration to RLI onset. Since nirsevimab is a passive immunization and concentration is expected to wane over time, it is important to continue monitoring effectiveness to assess effectiveness with increased time since dose. Funding: This work was supported by the Centers for Disease Control and Prevention (contracts 75D30121D12779 to Westat and 75D30123C18039 to Kaiser Foundation Hospitals). © 2025 Elsevier B.V., All rights reserved.

BACKGROUND: Respiratory syncytial virus (RSV) causes a large burden of illness among infants and young children, accounting for 50,000 hospitalizations annually in U.S. children under two years of age. RSV-related illness can require outpatient, emergency department, and hospitalized medical care contributing to significant medical and nonmedical economic burden. Further, the symptoms associated with RSV can reduce quality of life in children and their caregivers. Presently, the economic burden of RSV illness for children and their caregivers is largely unresearched. The objective of this study was to estimate the financial, time, and quality of life burdens associated with pediatric RSV illness for children and their caregivers. METHODS: Surveys were developed to measure the out-of-pocket costs, time costs, and caregiver quality of life associated with medically attended RSV illness. Caregivers of pediatric (age 0-17 years) patients with RSV illness seen at Michigan Medicine were invited by email and text message between October 2022 and June 2023 to complete the online surveys. RESULTS: Mean out-of-pocket medical costs for outpatient and emergency department (ED) visits were more than $500 per case. Mean out-of-pocket medical costs associated with hospitalizations, with an average length of stay of 6 days, were $1290 per case. Non-medical costs ranged from $83-$267 depending on health care service utilized. Mean time spent traveling, waiting, and receiving care in outpatient and ED settings was 9 h per case. Caregivers spent an average of 3.5 days caring for their non-hospitalized child with RSV illness and 11.6 days caring for their child who was hospitalized. Quality-adjusted life years (QALYs) lost for caregivers was 0.011-0.019. QALYs lost per episode for the sick child ranged between 0.0161 and 0.087 for outpatient episodes of illness and hospitalization, respectively. CONCLUSIONS: This study demonstrated the high financial burden and consequences to quality of life experienced by children with RSV illness and their caregivers, especially when the child was hospitalized due to their illness. Use of these findings will be valuable for evaluating the cost effectiveness of treatments and preventative measures from the perspective of caregivers, and understanding the complete economic burden of RSV illness.

BACKGROUND: Nipah virus (NiV) causes deadly outbreaks in Bangladesh, with fatality rate of 71%. Two sublineages, NiV-BD 1 and NiV-BD 2, have been identified. This study aimed to characterize their epidemiological and clinical diversity. METHODS: This study analyzed 21 new (2016-2023) and 17 previously (2012-2015) reported NiV genome sequences and compared sublineages using descriptive and bivariate analysis. RESULTS: Median age of sequenced cases was 17 years (IQR: 9-30); with 66% male. Raw date palm sap consumption was main transmission pathway (92%). NiV-BD 2 showed broader geographic distribution, including southern region. The sublineages did not differ significantly in age, sex, or transmission modes. Both sublineages presented with fever, altered mental status, and unconsciousness. Respiratory distress was more frequent in NiV-BD 2 (23/29 cases), while hospitalization was longer for NiV-BD 1 (median: 3 days; IQR: 1-23). Overall mortality was 84%, with no significant difference between sublineages. Phylogenetic analysis demonstrated that NiV-BD 1 and NiV-BD 2 formed distinct clusters with 98.72%-99.25% nucleotide and 99.98%-99.99% amino acid identity. The structural nucleoprotein (N) and matrix (M) proteins remained conserved across sublineages. CONCLUSION: This study highlights genetic, spatio-temporal and clinical variation between sublineages, emphasizing continuous genomic surveillance to inform future vaccine and therapeutic strategies.

BACKGROUND: Influenza B epidemics can have substantial public health impact. We aimed to estimate the mortality burden associated with influenza B virus infections over a 7-year period in Hong Kong. METHODS: Age- and cause-specific (i.e., respiratory diseases, circulatory diseases, renal diseases and other causes) and all-cause mortality rates in Hong Kong from 2014 through 2023 were fit to linear regression models with influenza B virus lineages as covariates. The influenza-associated excess mortality from influenza B viruses was estimated as the difference between fitted death rates with or without influenza B virus activity. RESULTS: Between 2014 and 2023, B/Yamagata predominated in four seasonal epidemics but eventually disappeared in 2020. In contrast, B/Victoria was predominant only in 2016, with influenza A(H1N1) and B/Yamagata co-circulating during that year. The annual respiratory excess mortality rate associated with influenza B was 3.5 (95% credible interval (CrI): 2.4, 4.6) per 100,000 person-years. We estimated an average of 260 (95% CrI: 180, 340) excess deaths associated with influenza B annually from 2014 through 2023, with a majority of the excess deaths occurring in adults >/=65 years of age. Influenza B/Yamagata epidemics were associated with more excess deaths than influenza B/Victoria, and the majority of influenza-associated deaths were from respiratory causes. CONCLUSIONS: Influenza B was associated with mortality burden each year, mainly among older adults, from 2014-2023. The disappearance of influenza B/Yamagata since 2020 suggests that influenza B burden will be lower in the future.

OBJECTIVES: Historically, the most frequent cause of death reported to the Centers for Disease Control and Prevention (CDC) among travelers on conveyances has been cardiovascular disease, mirroring all-cause mortality in the US population. Infectious disease transmission, particularly during large-scale outbreaks, also poses a risk to travelers. To determine leading causes of death on conveyances and whether they were affected by the COVID-19 pandemic, we describe causes of death on conveyances reported to CDC from 2008 through 2022. METHODS: We queried CDC's Port Health Activity Reporting System for traveler deaths on, or immediately after disembarking from, an aircraft or maritime vessel or during land-border crossings reported to CDC from July 1, 2008, through December 31, 2022. We examined data on cause of death, age, travel mode, and traveler type (passenger vs crew). We also calculated crude annual mortality rates for each conveyance type. To assess factors associated with deaths due to infectious diseases (vs deaths due to noninfectious conditions), we performed logistic regression. RESULTS: During the analysis period, 2910 deaths on conveyances were reported. Across all conveyances, the most common causes were cardiovascular- or pulmonary-related conditions (2116 of 2910; 73%) for each year except 2020, when COVID-19 was the most common. Crew (vs passengers) had significant associations with death due to infectious causes (vs noninfectious causes; adjusted odds ratio = 2.12; 95% CI, 1.32-3.40). CONCLUSIONS: Travelers with cardiovascular- or pulmonary-related conditions should consult their health care providers prior to international travel. All travelers should check travel recommendations such as those currently available on CDC travel pages. Public health authorities should consider population-based mitigation measures aimed at transmission risk reduction to limit morbidity and mortality during infectious disease outbreaks.

Carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) poses a public health issue. Rapid detection of CP-CRE colonization is challenging; existing methods are either expensive or time-consuming. We evaluated an immunochromatographic test (ICT) for detecting carbapenemases directly from broth-enriched rectal swabs. One hundred intensive care patients provided 178 pairs of rectal swabs. One swab was tested using the GeneXpert Carba-R PCR assay; the other was inoculated into brain-heart infusion broth. After 4 and 6 h of incubation at 37 degrees C, the broth was tested with the RESIST-5 O.K.N.V.I. ICT for Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), oxacillinase-48 (OXA-48), Verona integron-encoded metallo-beta-lactamase (VIM), and imipenemase (IMP) carbapenemases. Broths were subcultured after overnight incubation, and recovered carbapenem-resistant Enterobacterales isolates were tested using GeneXpert Carba-R PCR. Sensitivity, specificity, and accuracy were calculated in comparison to culture positive for CP-CRE, confirmed by PCR for KPC, NDM, OXA-48, VIM, and IMP. Of the 178 swabs, 60 were culture positive for CP-CRE. After 6 h, the ICT demonstrated a sensitivity of 65%, specificity of 97.5%, and accuracy of 86.8%. Among heavily soiled swabs, sensitivity reached 81.8% for ICT after 6 h, and the specificity was 100%. The mean execution time for carbapenemase detection using ICT was reduced by 60 h compared to culture. The ICT after 6 h incubation offers reduced execution time for detecting CP-CREs. This method may serve as a valuable rapid screening tool, especially in resource-limited settings.IMPORTANCEThe rapid spread of multidrug-resistant bacteria requires innovative solutions for early detection and prevention measures. In this study, we present a simple protocol for the direct detection of carbapenemases in rectal swabs using an immunochromatographic assay. By optimizing the assay conditions, we achieved rapid and high-accuracy identification of five clinically important carbapenemases. This method can broaden access to rapid CP-CRE detection of fecal colonization-even in laboratories with limited resources-enabling the implementation of faster and more effective infection control measures, potentially reducing the spread of resistance.

IMPORTANCE: Evidence is needed on the economic favorability of a 2023-2024 COVID-19 vaccination program to support policy decisions on recommendations for COVID-19 vaccination. OBJECTIVE: To measure the cost-effectiveness of vaccination with a 2023-2024 COVID-19 mRNA vaccine in adults aged 18 years or older compared with no updated vaccination (with a 2023-2024 vaccine). DESIGN, SETTING, AND PARTICIPANTS: This decision analytic modeling study used a simulation model to compare outcomes for hypothetical cohorts of vaccinated and unvaccinated, immunocompetent adults stratified by age (18-49 years, 50-64 years, and >/=65 years). Parameters were drawn from primary and published data to represent characteristics of the US adult population. The interventions included vaccination with a 2023-2024 mRNA vaccine against COVID-19-associated illness compared with no updated vaccination (with a 2023-2024 vaccine) using a 1-year analytic time frame. A phase 2 analysis also considered an intervention strategy of vaccination with an additional dose of 2023-2024 COVID-19 mRNA vaccine. MAIN OUTCOME AND MEASURE: The incremental cost-effectiveness ratio as reported in 2023 US dollars per quality-adjusted life-year. RESULTS: Vaccination averted substantial numbers of cases, hospitalizations, intensive care unit stays, and deaths across age groups. For adults aged 18 to 49 years and 50 to 64 years, vaccination yielded incremental cost-effectiveness ratios of $115 588 and $25 787 per quality-adjusted life-year gained, respectively. For individuals aged 65 years or older, vaccination was cost saving. Sensitivity analyses indicated that the results were most sensitive to the cost per vaccine dose, vaccine effectiveness, and probability of hospitalization. In phase 2 analyses, an additional dose strategy was only economically favorable in higher-risk scenarios for individuals aged 65 years or older. CONCLUSIONS AND RELEVANCE: In this modeling study, economic favorability of COVID-19 vaccination varied by age. Cost-effectiveness results for individuals in the 2 older age groups were favorable and generally robust to changes in parameter inputs, while results for the younger age group were sensitive to parameter input changes. As the evidence base for COVID-19 vaccination and burden of illness evolves, it may be important to continue to update and revise the economic evaluation of vaccination. The Advisory Committee on Immunization Practices considered these results in its decision to recommend vaccination with the 2023 to 2024 COVID-19 mRNA vaccines.

Commutability assessment of a certified reference material (CRM) intended for use as a secondary calibrator should be performed by the CRM producer at the time the material is originally prepared. Assessment typically includes several in-vitro diagnostic (IVD) measurement procedures (MPs) in common use in medical laboratories. Due to logistical constraints, it is usually not possible to include all existing IVD-MPs in a commutability assessment. In addition, a new IVD-MP (IVD-MP(n)) may be introduced into the market after a commutability assessment was performed for a given CRM. Here we provide a recommendation how to assess commutability of an existing CRM for use with an IVD-MP(n) that was not included in the original commutability assessment. The study design follows the same principles as a full commutability assessment, but it includes only the IVD-MP(n) and fewer additional comparator MP(s) for which the CRM's commutability with clinical samples was previously demonstrated. When no reference measurement procedure (RMP) is available, or when the logistics make an RMP difficult to use, other IVD-MP(s) that were part of the original commutability assessment for the CRM should be used as comparator MP(s). When selecting a comparator IVD-MP, its performance must be carefully considered and its selectivity for the measurand should be equivalent to that of the IVD-MP(n). The CRM should have had negligible noncommutability bias with the comparator IVD-MP in the original commutability assessment. When the existing CRM meets the commutability criterion for IVD-MP(n), the CRM can be used in the calibration hierarchy of the IVD-MP(n).

This study addresses the critical need for improved identification of suspected sex trafficking (SST) victims in emergency departments (ED). An analysis of data from the National Syndromic Surveillance Program identified 1,427 SST-related ED visits from January 2019 to December 2023: 1,267 females and 156 males. The highest rates of SST visits were observed in females aged 12–17 (0.37 per 10,000 visits). Rates varied by ethnicity, with American Indian or Alaska Native females at 0.18 per 10,000 visits. Results underscore the importance of diagnosis codes and chief complaint text in identifying SST cases. © 2025 Elsevier B.V., All rights reserved.

Influenza A virus (IAV) infection of the respiratory tract can cause both respiratory and non-respiratory symptoms. Gastrointestinal (GI) symptoms such as diarrhea, vomiting, and abdominal pain can occur in persons with seasonal influenza A or novel IAV infections, but the extent to which IAVs can infect and replicate in GI tissues is understudied. The ongoing outbreak of A(H5N1) IAV in US dairy cattle associated with sporadic human infections has highlighted the potential public health threat posed by the introduction of infectious virus into materials that may be consumed by humans, such as milk. Here, we review epidemiologic reports documenting the frequency of GI complications in humans infected with seasonal and novel IAVs and present laboratory studies supporting the capacity of IAV to replicate in mammalian GI tissues, with an emphasis on A(H5N1) viruses. Studies assessing the ability of IAV to cause mammalian infection following consumption of virus-containing material are also presented. Collectively, these studies suggest that gastric exposure represents a potential non-respiratory route for A(H5N1) IAVs in mammals that can lead to infection and support that IAV may be detected in mammalian intestinal tissues following multiple exposure routes.

Digital PCR (dPCR) systems offer high sensitivity and reproducibility without requiring external control standards. However, their performance against real-time reverse transcription-PCR (rRT-PCR) for detecting respiratory viruses remains unexplored in Ghana. We therefore evaluated the performance of a novel dPCR, Lab-On-An-Array (LOAA), for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respiratory syncytial virus (RSV), and influenza viruses type A (Flu A) and B (Flu B). A cross-sectional hospital-based study was conducted between August 2022 and January 2023 in Ghana's Ashanti and Savannah Regions. Oropharyngeal swabs from 356 participants with a median age of 19 years, presenting with suspected respiratory illness, were tested using LOAA and rRT-PCR. Viral RNA was extracted using a Qiagen Viral Mini Kit (Qiagen Diagnostics GmbH, Germany). LOAA and rRT-PCR tests were performed using Genoplexor COVID-19/Flu/RSV Detection Kit (Optolane Technologies Inc, South Korea) and FluoroType SARS-CoV-2/Flu/RSV kits (Hain Lifescience GmbH, Germany), respectively. LOAA's performance metrics were assessed using rRT-PCR as the gold standard. Overall positivity rates were 29.78% and 30.90% for LOAA and rRT-PCR, respectively. Compared to rRT-PCR, LOAA's sensitivity was 87.76% for RSV, 91.30% for SARS-CoV-2, 86.21% for Flu B, and 88.89% for Flu A. Positive predictive value was the highest for RSV (97.73%) and lowest for Flu A (61.54%); negative predictive values were >/=98.00% for all respiratory viruses. LOAA recorded an "almost perfect" agreement (kappa >/=0.88) with rRT-PCR for RSV, SARS-CoV-2, and Flu B and good agreement for Flu A (kappa = 0.72). LOAA is sensitive in detecting SARS-CoV-2, RSV, and Flu B infections; however, minor improvements for Flu A are required. IMPORTANCE: This study presents the potential of a digital PCR as a highly sensitive and reproducible tool for detecting respiratory viruses in Ghana, where robust diagnostic methods are essential for managing public health challenges. By evaluating the novel Lab-On-An-Array (LOAA) system, we provide its critical operational performance against the gold-standard rRT-PCR for detecting severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus, and influenza viruses. Our findings show that LOAA demonstrates excellent agreement with rRT-PCR for most viruses, offering a promising alternative for respiratory virus surveillance and diagnosis. This research is particularly significant for resource-limited settings, as it supports the adoption of advanced molecular diagnostics to improve early detection and response to respiratory infections. Minor refinements for specific viruses, such as influenza A, could further enhance its utility in clinical and epidemiological applications.

OBJECTIVE: The traditional syphilis screening algorithm, which involves a nontreponemal assay followed by confirmatory treponemal testing, has been challenged by an alternative approach known as the reverse sequence algorithm. The latter reverses the order of the tests and incorporates a second treponemal test for discordant results. Although the reverse sequence may offer operational advantages, there is a need for formal cost-effectiveness analyses to compare these two syphilis screening alternatives. METHODS: We conducted cost-effectiveness analyses from the health care sector perspective to compare the reverse sequence with the traditional algorithm. We employed a decision tree for pregnant women in prenatal care that included the possibility of congenital syphilis outcomes. A simulated a cohort of 10,000 people was screened over 1 year to estimate total costs and quality-adjusted life-years (QALYs) under each algorithm. We estimated incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to identify influential parameters affecting the ICERs and to conduct scenario analyses. RESULTS: During prenatal care, the reverse sequence detected four more cases, overtreated 185 more individuals, and prevented 0.42 more congenital syphilis cases (ICER $463,735/QALY gained), when compared with the traditional algorithm. Sensitivity analyses revealed that syphilis prevalence had the greatest effect on the ICER. To achieve ICERs below $50,000/QALY gained, syphilis prevalence would need to exceed 6% during prenatal care. CONCLUSION: Our analysis indicates that, under likely parameter values, the reverse sequence algorithm is equally effective but more costly than the traditional algorithm and therefore not cost effective. Although treponemal test automation may offer potential savings in laboratory costs, these are outweighed by overtreatment costs.

BACKGROUND: Improved causes of death (CoD) understanding in low- and middle-income countries is needed to reduce child mortality. Compared to full autopsy, minimally invasive tissue sampling (MITS), using transcutaneous needle sampling, is a feasible, socially acceptable, and validated method. We aimed to quantify the additional contribution of MITS to CoD attribution based on clinical records and inpatient research data with intensive patient characterisation. METHODS: We enrolled children aged seven days to 59 months who died while on admission for acute illness and/or severe malnutrition to Queen Elizabeth Central Hospital in Blantyre, Malawi. Standard MITS procedures included histologic, immunohistochemical, and microbiologic testing. Phase 1 CoD determination was based on medical records alone, Phase 2 also included research data, and Phase 3 included all data, including from MITS. RESULTS: We enrolled 29 children. Based on clinical notes alone (Phase 1), we identified 60 causal and 39 contributing conditions. Of the 45 (45%) infectious conditions, pathogens were identified in 15 (33%). Only one patient's (3%) CoD was unchanged compared to including all data (Phase 3). Further, we identified 69 new (n = 43) or adjusted (n = 26) diagnoses among 28 cases (97%); the majority were undernutrition-related (n = 22, 32%) or infectious (n = 41, 59%) conditions. Overall, the majority of final Phase 3 conditions were also undernutrition-related (n = 46, 32%) or infectious (n = 61, 43%) and a pathogen was identified in 54 (89%) of the infectious conditions. Klebsiella pneumoniae was the most prevalent aetiology in both pneumonia and sepsis. CONCLUSIONS: The addition of MITS to clinical and inpatient research data led to almost all (97%) of cases receiving new and/or refined diagnoses, including microbe identification in infectious conditions. Pathogens not specifically addressed by current clinical guidelines, such as Klebisiella pneumoniae, were commonly identified. Our findings support the utility of MITS to understand CoD even after thorough clinical characterisation of children during hospitalisation.

Approximately 12.5 million young children are cared for in early care and education (ECE) settings at least once per week, making ECE an important setting to support nutrition, physical activity (PA), breastfeeding, and other health and wellness topics. National standards have been developed for the ECE setting, but the extent to which nutrition and PA standards are being translated to everyday policies and practices is unknown, as information has not been collected in a consistent way across states and communities. This brief report provides descriptive data from 221 ECE centers in four states in 2021 using a standardized survey called the Childcare Survey of Activity and Wellness (C-SAW). Information on the development, piloting, resulting descriptive data, and future implications for C-SAW in public health practice are presented in this brief. The C-SAW survey and all ancillary materials are freely available for use by public health professionals in states and communities to better understand ECE programs in their jurisdictions or to evaluate efforts to improve nutrition, PA, breastfeeding, and other health topics over time.

This study characterizes the sample size and precision for infant and young child feeding (IYCF) indicators evaluated in surveys conducted in refugee settings, characterized by sample sizes enabling timely information to inform humanitarian response. We analyzed surveys provided by the United Nations High Commissioner for Refugees conducted from 2013 to 2019. For eight IYCF indicators recommended in the current global guidance, we assessed achieved sample sizes and precision by evaluating the half-width of 95% confidence intervals (HWCIs) by survey design. Among cluster surveys, we characterized the intraclass correlation coefficients (ICCs) and design effects. Final analysis included 203 surveys from refugee settings in 15 countries. Ever breastfed and bottle feeding indicators were the most precise (median HWCI: 3.1% and 3.6%) due to inclusion of all children 0-23 months resulting in relatively large sample sizes and estimates of prevalence close to 100% and 0%, respectively. Exclusive breastfeeding under 6 months and the introduction of solid foods (6-8 months) had the lowest precision (median HWCI estimates: 12.6% and 18.2%). In cluster surveys, early initiation of breastfeeding and flesh food consumption stood out with markedly higher design effects (median estimates: 2.63 and 2.17) driven by relatively larger sample sizes and high ICCs (median estimates: 0.31 and 0.27); all other indicators had median design effects < 1.3. Evidence on expected variation in precision and heterogeneity by indicator can help design surveys with samples that allow for the rapid collection of data sufficient to inform emergency responses. High caution is needed when interpreting estimates of exclusive breastfeeding and introduction of solid foods in past surveys given lower precision.

The objective of this analysis is to examine characteristics of very preterm (VPT), very low birth weight (VLBW) infants not admitted to neonatal intensive care units (NICU). In this cross-sectional study assessing VPT (<32 weeks gestation) and VLBW (<1500 grams) infants, we used birth records from the National Vital Statistics System, 2021. Crude and adjusted prevalence ratios (aPR) with modified Poisson regression models were used to calculate prevalence of infants not admitted to the NICU by selected characteristics. Among 38,693 VPT, VLBW infants, 10% were not admitted to the NICU. In the adjusted model, characteristics associated with a higher prevalence of not being admitted to the NICU compared with analytical reference groups included non-Hispanic Native Hawaiian/Other Pacific Islander (aPR = 1.61;95% confidence interval [CI]:1.13-2.29), gestational age 22-24 weeks (aPR = 1.17;CI:1.08-1.26), vaginal delivery (aPR = 1.83;CI:1.73-1.94), and 5-minute Apgar score of 0-3 (aPR = 3.48;CI:3.18-3.82). Exploration of reasons infants were not admitted to the NICU may elucidate strategies to address barriers.

OBJECTIVE: Emergency allotments were issued in the Supplemental Nutrition Assistance Program (SNAP), the largest program addressing food insecurity in the United States, during the COVID-19 pandemic. These emergency allotments temporarily increased the amount of monthly food purchasing assistance received by SNAP-participating households. Our aim was to examine the association of the end of SNAP emergency allotments with food insufficiency and difficulty affording expenses, overall and among households with and without children. METHODS: We used March 2021-April 2022 Household Pulse Survey data from respondents in four states that ended emergency allotments in August 2021 ("earlier ender" states) and eight states that ended emergency allotments after the end of the study period (comparison states). We conducted difference-in-differences analyses to compare changes in the risk of food insufficiency and difficulty affording expenses from before to after the end of emergency allotments in August 2021 between SNAP-participating households in "earlier ender" states and comparison states. RESULTS: Earlier ending of SNAP emergency allotments was associated with a 5.0 percentage point increase in the risk of food insufficiency (risk difference (RD) = 0.05, 95 % confidence interval (CI) 0.03, 0.07) and an 8.0 percentage point increase in the risk of difficulty affording expenses (RD = 0.08, 95 % CI 0.06, 0.09). The increase in the risk of food insufficiency was slightly larger for households with children (RD = 0.06, 95 % CI 0.03, 0.09) than households without children (RD = 0.04, 95 % CI 0.00, 0.08). CONCLUSIONS: SNAP benefit reductions after the end of emergency allotments were associated with difficulty affording food and household expenses among households with and without children.

Workplace exposure to 4,4'-methylene diphenyl diisocyanate (MDI), the most used monomeric diisocyanate, can lead to the development of occupational asthma (OA). However, the molecular mechanisms by which MDI induces OA remain poorly understood. Previous studies have shown that exposure to MDI or MDI-glutathione (GSH) conjugate reduces the levels of endogenous human (hsa)/murine (mmu)-microRNA(miR)-206/381-3p, triggering the activation of calcineurin/nuclear factor of activated T cells (NFAT)/inducible nitric oxide synthase (NOS2) regulatory axis and Kruppel-Like Factor 4 (KLF4)/chemokine pathways in macrophages. Circular RNAs (circRNAs) play important roles on miR and miR-mediated functions in the cells. CircRNA hsa_circ_0008726 is induced by MDI-glutathione (GSH) to downregulate endogenous hsa-miR-206-3p in macrophages; however, the MDI-GSH mediated circRNA response to downregulate hsa-miR-381-3p is currently unknown. The expression of previously identified candidate circRNAs that bind hsa-miR-381-3p were analyzed in differentiated/enhanced THP-1 macrophages treated with MDI-GSH conjugates using RT-qPCR. MDI-GSH exposure induces endogenous hsa_circ_0099188 and its host gene thyrotropin-releasing hormone-degrading ectoenzyme (TRHDE); however, other candidate circRNAs were neither detected nor altered. RNA immunoprecipitation (RIP) experiments confirmed the binding of hsa-miR-381-3p to hsa_circ_0099188. Further experiments demonstrate that modulating hsa_circ_0099188 expression through siRNAs or overexpression plasmids alter the levels of endogenous hsa-miR-381-3p, PPP3CA, and KLF4, as well as NOS2 and M2 macrophage-associated markers and chemokine transcripts. These findings suggest that MDI/MDI-GSH exposure leads to the downregulation of hsa-miR-381-3p by inducing the expression of hsa_circ_0099188/TRHDE, thereby enhancing the regulatory effects of hsa-miR-381-3p in macrophages.

HIGHLIGHTS: Comprehensive view of occupational safety research: Prioritizing topics in robotics and autonomous machines. Barriers to safety research: Logistical, intellectual property, timeline, and funding challenges. Importance of surveillance or tracking system: Documenting fatalities, injuries, and near misses/good catches. Priority safety research needs: human-machine interaction, adoption of automation in the work setting, and surveillance/tracking. Collaboration with technology developers: Overcoming barriers and exploring emerging technologies and potential safety implications. ABSTRACT: In 2022, the SAfety for Emerging Robotics and Autonomous AGriculture (SAFER AG) Workshop was held to discuss and understand emerging challenges related to safety, occupational safety research needs, workforce implications, and other issues associated with robotics and autonomous machines in agriculture. This paper presents the major findings from the occupational safety research track of the workshop. This track identified existing hurdles to conducting occupational safety research including logistical barriers, intellectual property concerns, long timelines, and lack of funding. Considerations for developing a tracking or surveillance system for adverse events as well as exposure related to these technologies were also discussed, emphasizing the need for a comprehensive system. Finally, the priority occupational safety research needs identified during the session were related to human and non-human machine interaction, adoption of automation in the work setting, and event tracking/surveillance. To overcome barriers to research, collaboration between occupational safety researchers and technology developers is crucial. Enhancements to existing surveillance systems can facilitate better understanding of captured events. Additionally, prioritizing research on worker risk from robotics and autonomous machines in agriculture is essential. The integration of robotics and autonomous machines in agriculture has revolutionized the industry but requires evidence-based safety research, outreach, and education to ensure worker safety and health.

Monitoring the emergence and spread of drug-resistant parasites is essential for effective malaria control. Here, we describe the prevalence of genetic markers of Plasmodium falciparum antimalarial drug resistance and parasite population structure in Mozambique. Drug resistance loci and microhaplotypes were genotyped by multiplex targeted amplicon sequencing of 1146 P. falciparum samples collected in 2021 (n = 321) and 2022 (n = 825 rainy season, and n = 155 dry season). pfpm2 gene copy number (associated to piperaquine resistance) was assessed using real-time quantitative PCR. No pfk13 markers of partial artemisinin resistance nor pfpm2 duplications were observed. Prevalence of pfdhfr/pfdhps quintuple mutants associated with sulfadoxine-pyrimethamine (SP) resistance was high across all regions (> 92.5% in 2021 and > 87.8% in 2022), but pfdhps-A581G mutation was rare (1.6% in 2021 and 0.8% 2022). Both prevalence of mutations in pfdhps-436 (p < 0.001) and genetic complexity of infections increased from South to North. These results support the continued use of artemisinin-based combination therapies in Mozambique, call for a close monitoring of chemopreventive efficacy based on SP, and confirm the spatial genetic distinction in P. falciparum population observed across the country.

Despite significant progress in reducing malaria effects in recent decades, malaria remains a major challenge in Madagascar. Geographic and financial barriers often prevent individuals from seeking prompt care. Community health workers (CHWs) in many countries, including Madagascar, provide malaria case management services to children younger than 5 years old, although they typically do not treat older children and adults, leaving a gap for those living far from health facilities. To determine the efficacy of expanding malaria community case management (mCCM) to community members of all ages, a cluster randomized trial was conducted in one district of Madagascar from November 2020 to December 2021. Qualitative surveys were conducted to describe the acceptability and feasibility of this intervention among beneficiaries and CHWs. For this purpose, 87 semistructured interviews and 12 focus groups were conducted in intervention and control arms of the study to assess understanding of malaria, behaviors related to care seeking for fever, perceptions of CHW roles, and acceptability and feasibility of the age-expanded mCCM. Two major findings emerged. First, stakeholders found age-expanded mCCM to be consistent with existing CHW roles and practices. Age-expanded mCCM induced a recognition of adults' susceptibility to malaria and led to a more accurate understanding of malaria. Second, structural and community-based challenges were not fully resolved by age-expanded mCCM, and some, such as the question of the cost of care, emerged after its implementation. Despite the fact that age-expanded mCCM was acceptable to beneficiaries and CHWs, successful scale-up will require addressing structural challenges and sociodemographic inequalities.

CONTEXT: Public health fellowship programs play a vital role in strengthening the workforce across state, tribal, local, and territorial (STLT) public health agencies. PROGRAM: The US Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS) and Laboratory Leadership Service (LLS) fellowships provide structured opportunities for trainees to be placed within STLT public health agencies, where they are intended to contribute directly to essential public health functions. Through these assignments, the objective is for trainees to gain practical experience while STLT public health agencies benefit from additional capacity and public health expertise. EVALUATION: Findings from a rapid evaluation showed that EIS and LLS trainees offer crucial support to STLT public health agencies' delivery of Foundational Public Health Services. The trainees also provide surge support during emergency response events, including infectious disease outbreaks and environmental toxins. DISCUSSION: Public health fellowships are a collaborative model of how federal programs can help alleviate longstanding public health workforce challenges, including difficulties recruiting, hiring, and retaining qualified professionals. Integration of trainees into STLT public health agency operations fosters knowledge transfer, strengthens local capabilities, and supports sustained delivery of public health services. Our findings provide additional evidence that public health fellowship programs can serve as essential support for the national public health workforce.

CONTEXT: Public health agencies require a competent, well-trained workforce to protect health and meet the specific needs of the communities served. In the US-Affiliated Pacific Islands (USAPI), geographic and educational barriers, and limited availability of culturally and linguistically appropriate training programs are unique challenges that contribute to public health workforce shortages. PROGRAM AND IMPLEMENTATION: The Pacific Public Health Fellowship Program (PPHFP) was introduced through a partnership between the Centers for Diseases Control and Prevention and the Pacific Island Health Officers Association. It was designed to address barriers to public health workforce development and capacity in USAPI. Established in 2019, PPHFP is a 2-year, full-time training program designed for USAPI residents who are recent college graduates with interests in pursuing careers in public health. The program includes a competency-based training curriculum and field-based projects at participating host sites to address local public health challenges. PPHFP has expanded from 2 fellows in 2021 to 43 fellows in 2024, with each USAPI having hosted fellows. EVALUATION: All 2021-2023 cohort respondents to the PPHFP exit survey have reported satisfaction with the program, increased knowledge and skills in public health, and readiness to enter the public health workforce. In addition, respondents reported that they have contributed to public health workforce capacity at their local host sites. In total, 16 of 17 graduates from these cohorts have been employed or continued their education in the public health field. DISCUSSION: PPHFP is a successful approach to addressing unique public health workforce challenges in USAPI through recruitment, training, and placement of residents at local host sites. This fellowship program can serve as a model for enhancing public health workforce capacity in other regions and globally.

Healthy People 2030 aims to decrease low-risk cesarean delivery rates to 23.6% in the United States. In 2023, the national rate was 26.6%, though rates vary widely by state and hospital. This suggests a need for localized geographic estimates to identify places with higher burden. We modeled 2023 low-risk cesarean delivery rates by county of birth using birth certificate data and hierarchical Bayesian models that spatially smooth unstable estimates. We found considerable variation in rates, with county rates ranging from 5.8% to 53.4%. Counties in the West had lower rates than those in the Midwest, South, and Northeast. County rates increased with urbanicity. Only 47.7% (985) of counties had rates meeting the Healthy People 2030 target.

BACKGROUND: Phthalates are endocrine-disrupting chemicals that can dysregulate hormonal systems supporting female sexual function (eg, estrogen interference). Female sexual function is important for positive sexual expression, fertility, and well-being but remains understudied in the context of environmental toxicants to which females are ubiquitously exposed. Identifying environmental determinants of female sexual dysfunction can inform exposure-reduction strategies and clinical practice to improve sexual health. AIM: We investigated associations between phthalate exposure and sexual function in a cohort of North American females. METHODS: We leveraged cross-sectional data from a subset of 21-45-year-old females trying to conceive enrolled in Pregnancy Study Online (n = 347) to assess associations between phthalate and phthalate alternative exposure and sexual function, measured on a modified version of the Female Sexual Function Index-6 (FSFI-6). We summed FSFI-6 responses (range = 2-30); lower scores reflected poorer function. We measured urinary concentrations of 18 phthalate and alternative metabolites using online solid phase extraction coupled with high-performance liquid chromatography isotope dilution tandem mass spectrometry. Given that the biomarkers were nonlinearly associated with FSFI-6 scores, we categorized creatinine-corrected biomarker concentrations in tertiles. We used multivariable linear regression to estimate mean differences (beta) with 95% confidence intervals (CIs) in FSFI-6 scores per tertile increase in biomarker concentrations, adjusting for hypothesized confounders. In secondary analyses, we considered individual FSFI-6 items (range = 1-5) as outcome variables. OUTCOMES: Female sexual function measured on the FSFI-6. RESULTS: Most biomarkers were not associated with FSFI-6 scores. Mono-n-butyl phthalate concentrations were weakly and non-monotonically associated with lower summed FSFI-6 scores (beta = -0.8, 95% CI = -1.8, 0.2) and orgasm scores (beta = -0.3, 95% CI = -0.7, 0.1) at the second (vs first) tertile, reflecting poorer sexual function. Mono-2-ethyl-5-carboxypentyl terephthalate concentrations were weakly associated with poorer scores for orgasm, while other biomarkers (notably, mono-carboxyisononyl phthalate) were associated with higher summed FSFI-6 and FSFI-6 item scores. CLINICAL IMPLICATIONS: Exposure to phthalates should be considered in clinical settings, particularly for females experiencing issues with sexual function. STRENGTHS AND LIMITATIONS: This study represents one of the first to assess associations of phthalate exposure and female sexual function, and we investigated associations in an established cohort with a validated measure of sexual function. We were limited by our sample size and cross-sectional study design. CONCLUSION: Although associations for most phthalate biomarkers were null, some were weakly associated with female sexual function, suggesting exposure to certain chemicals may affect female sexual function with implications for clinical practice and exposure reduction strategies.

BACKGROUND: The Centers for Disease Control and Prevention offered a multicomponent intervention called Local Opioid Overdose Prevention and Response (LOOPR). Five sites (Bell, KY, Boone, WV, Manchester, NH, St. Francois, MO, and Ware, GA) were selected to implement academic detailing (AD). AD is a strategy for communicating safer opioid prescribing practices to clinicians. This is the first study to assess changes in county-level opioid prescribing behaviors after implementing a multicomponent prevention program emphasizing AD. OBJECTIVES: We examined three opioid prescribing behaviors (percentage of opioid prescribers in the top centile nationally, opioid prescribing rate, and average number of opioid prescriptions per prescriber) before and after program implementation in each site and a paired control. We used paired interrupted time series to examine the effect of LOOPR on each outcome for each site and control. RESULTS: Five jurisdictions incorporated AD as part of LOOPR. In addition, Bell County, KY implemented three other interventions (coalition establishment, communication campaign, and community-based overdose prevention program). Manchester City, NH (community-based overdose prevention program and public health/public safety partnership) and St. Francois, MO (communication campaign and public health/public safety partnership) implemented two additional interventions. Boone County, WV and Ware County, GA only incorporated AD. Though not always statistically significant, all sites showed decreasing or stabilizing trends after implementation of LOOPR for most outcomes. CONCLUSIONS/IMPORTANCE: This study shows AD is a versatile strategy and customizable activity that can be implemented in many settings as a separate activity or integrated with various prevention programs, making it particularly suitable for community-level interventions.

While many states have expanded alcohol delivery policies, data are limited on where US adults obtain alcohol, often not specifying alcohol delivery. This study assessed sources of how adults obtained their alcohol, by sociodemographic characteristics and drinking patterns. Among the 2200 adult respondents to the 2024 SummerStyles survey who drink, 4 logistic regressions were used to assess adjusted odds ratios between sociodemographic characteristics and how respondents obtained their alcohol during the past 30 days. Respondents could select more than 1 source, if applicable. Obtaining alcohol from off-premises outlets was most common (73.9%), followed by on-premises outlets (49.9%); 2.4% reported using delivery. Compared to adults who did not binge drink, binge drinking was associated with almost twice the odds of using alcohol delivery. This study underscores the usefulness of further research to assess the effects of alcohol policy changes that modify access to alcohol on excessive drinking and alcohol-related harms.

Viral coinfections and their impact on long-term immunity represent an understudied area in disease ecology and infectious disease research. Coinfections can influence the host's susceptibility to future infections, alter host and pathogen population dynamics, modify infection and shedding patterns, impose evolutionary pressures, and affect the risk of zoonotic spillover. Egyptian rousette bats (ERB; Rousettus aegyptiacus; common name: Egyptian rousettes) are a natural reservoir host for Marburg virus (MARV) and Ravn virus (RAVV), as well as a vertebrate reservoir for Kasokero virus (KASV) and a putative reservoir for Sosuga virus (SOSV). Viral coinfections have been documented in numerous free-ranging bat species as well as ERBs, raising questions about how these interactions influence immune responses, viral shedding, and pathogen maintenance within the natural host population. This is particularly critical given the genetic diversity among co-circulating viral species (e.g., MARV and RAVV) and the potential implications for the development of protective immunity and subsequent viral inoculation outcomes. In this study, ERBs previously infected with MARV alone or KASV + MARV were inoculated approximately 8 months later with homotypic (MARV) or heterotypic (RAVV) orthomarburgvirus isolates. The results demonstrated no viral replication or shedding post-inoculation, and all bats displayed strong secondary immune responses consistent with sterilizing immunity. These findings suggest that both MARV monoinfection and KASV + MARV coinfection confer robust protection against reinfection, regardless of the viral isolate. This research enhances our understanding of immune responses during viral coinfections in bats and their potential role in mitigating zoonotic pathogen spillover.IMPORTANCELong-term immunity elicited in bats during coinfection (i.e., simultaneous infection) with viruses they naturally host is not well understood. These interactions could affect susceptibility to subsequent reinfection and pathogen spread. Egyptian rousette bats, natural hosts for several pathogenic zoonotic viruses, including Marburg and Kasokero viruses, can be found multiply infected in the wild, but the immune consequences of being coinfected remain unclear. Here, bats previously infected with either Marburg virus alone or with both Kasokero and Marburg viruses were later challenged with Marburg virus or the related Ravn virus. No reinoculated bats showed signs of virus replication, and all mounted strong immune responses. These results suggest that this coinfection combination still provides robust protection against reinfection, even with diverse orthomarburgviruses. This study helps improve our understanding of how bats manage viral coinfections and may inform how these interactions influence zoonotic spillover risk.

Ticks and tickborne diseases are of increasing concern in the United States, and the burden is high in certain focal areas. While the acceptability of various tick control and disease prevention methods has been studied, the public's willingness to pay for environmental interventions at the individual or community level is less well described. Using data collected as part of a larger survey, we performed an additional analysis of residents of Lyme disease-endemic counties of Michigan, Minnesota, and Wisconsin to assess their willingness to support and pay annually for various methods of property-based tick control and examined demographic characteristics that might influence willingness to pay. Seventy-nine percent of respondents were willing to perform some form of tick control on their property, with most preferring self-application. Landscaping and natural pesticide application were the most popular options, with people willing to pay an estimated $78 and $61 annually, respectively. High income, a high perceived prevalence of disease, and a high perceived likelihood of disease were all associated with a willingness to pay more. When asked about a community control option, 97 % of respondents indicated interest, with respondents being willing to pay $52/year for a community-based program regardless of household characteristics. These results suggest a moderate demand in the Upper Midwest for tick control efforts at both the individual property level and for local, publicly funded, community-based programs. These findings provide a starting point for assessing community characteristics, cost structure, environmental attributes, and efficacy needed to generate net benefits for community-based tick control programs.