Volume 12, Issue 17, June 2, 2020
CDC Science Clips: Volume 12, Issue 17, June 2, 2020
Science Clips is produced weekly to enhance awareness of emerging scientific knowledge for the public health community. Each article features an Altmetric Attention scoreexternal icon to track social and mainstream media mentions!
This week Science Clips is pleased to feature articles from the CDC-organized Clinical Infectious Diseases supplement on “Plague and Bioterrorism Preparednessexternal icon.”
The introductory articleexternal icon notes:
“In this supplement of Clinical Infectious Diseases, organized by the Centers for Disease Control and Prevention, we have assembled a series of articles that address the most pressing questions related to plague. These articles, representing careful and diligent research efforts, have been curated to bring together an essential evidence base on the treatment of plague and considerations for special populations. . . . The aim with this work is to increase resilience and national security against plague by advancing scientific and medical knowledge in order to inform preparedness. This collection of foundational articles and the expertise behind them will provide a basis for efforts to augment defenses against plague in both the natural and intentional release settings and, hopefully, will spur future research.”
- Key Scientific Articles in Featured Topic
Subject matter experts decide what topic to feature, and articles are selected from the last 3 to 6 months of published literature. Key topic coincides monthly with other CDC products (e.g. Vital Signs).The names of CDC authors are indicated in bold text.
- Zoonotic and Vectorborne Diseases - Plague
Plague: Still a threat, but evidence and preparedness are keys to fighting backexternal icon
Adalja A, Nelson CA.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S1-s2.
Effect of delaying treatment on efficacy of ciprofloxacin and levofloxacin in the African green monkey model of pneumonic plagueexternal icon
Campbell JL, Fay MP, Lanning LL, Hewitt JA.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S60-s65.
Plague during pregnancy: A systematic reviewexternal icon
Fleck-Derderian S, Nelson CA, Cooley KM, Russell Z, Godfred-Cato S, Oussayef NL, Oduyebo T, Rasmussen SA, Jamieson DJ, Meaney-Delman D.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S30-s36.
Treatment of human plague: A systematic review of published aggregate data on antimicrobial efficacy, 1939-2019external icon
Godfred-Cato S, Cooley KM, Fleck-Derderian S, Becksted HA, Russell Z, Meaney-Delman D, Mead PS, Nelson CA.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S11-s19.
The African green monkey model of pneumonic plague and US Food and Drug Administration approval of antimicrobials under the animal ruleexternal icon
Hewitt JA, Lanning LL, Campbell JL.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S51-s59.
Antimicrobial treatment patterns and illness outcome among United States patients with plague, 1942-2018external icon
Kugeler KJ, Mead PS, Campbell SB, Nelson CA.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S20-s26.
Plague and pregnancy: Why special considerations are neededexternal icon
Meaney-Delman D, Oussayef NL, Honein MA, Nelson CA.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S27-s29.
Antimicrobial treatment of human plague: A systematic review of the literature on individual cases, 1937-2019external icon
Nelson CA, Fleck-Derderian S, Cooley KM, Meaney-Delman D, Becksted HA, Russell Z, Renaud B, Bertherat E, Mead PS.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S3-s10.
Safety of antimicrobials during pregnancy: A systematic review of antimicrobials considered for treatment and postexposure prophylaxis of plagueexternal icon
Yu PA, Tran EL, Parker CM, Kim HJ, Yee EL, Smith PW, Russell Z, Nelson CA, Broussard CS, Yu YC, Meaney-Delman D.
Clin Infect Dis. 2020 May 21;70(Supplement_1):S37-s50.
- Zoonotic and Vectorborne Diseases - Plague
- CDC Authored Publications
The names of CDC authors are indicated in bold text.
Articles published in the past 6-8 weeks authored by CDC or ATSDR staff.
- Chronic Diseases and Conditions
Filling the public health science gaps for diabetes with natural experimentsexternal icon
Gregg EW, Duru OK, Shi L, Mangione CM, Siegel KR, Ramsay A, Thornton PL, Clauser S, Ali MK.
Med Care. 2020 Jun;58 Suppl 6 Suppl 1:S1-s3.
Prevalence of and changes in tooth loss among adults aged >/=50 years with selected chronic conditions - United States, 1999-2004 and 2011-2016external icon
Parker ML, Thornton-Evans G, Wei L, Griffin SO.
MMWR Morb Mortal Wkly Rep. 2020 May 29;69(21):641-646.
Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USAexternal icon
Pollack LM, Ekwueme DU, Hung MC, Miller JW, Chang SH.
Cancer Causes Control. 2020 May 20.
- Communicable Diseases
Improvements in retention in care and HIV viral suppression among persons with HIV and comorbid mental health conditions: Patient-centered HIV care modelexternal icon
Byrd KK, Hardnett F, Hou JG, Clay PG, Suzuki S, Camp NM, Shankle MD, Weidle PJ, Taitel MS.
AIDS Behav. 2020 May 15.
Sudor Anglicus: an epidemic targeting the autonomic nervous systemexternal icon
Cheshire WP, van Gerpen JA, Sejvar JJ.
Clin Auton Res. 2020 May 20.
Confidential, accessible point-of-care sexual health services to support the participation of key populations in biobehavioural surveys: Lessons for Papua New Guinea and other settings where reach of key populations is limitedexternal icon
Kelly-Hanku A, Redman-MacLaren M, Boli-Neo R, Nosi S, Ase S, Aeno H, Nembari J, Amos A, Gabuzzi J, Kupul M, Williie B, Narokobi R, Hou P, Pekon S, Kaldor JM, Badman SG, Vallely AJ, Hakim AJ.
PLoS One. 2020 ;15(5):e0233026.
An investigation of early syphilis among men who have sex with men: Alaska, 2018: Findings from a 2018 rapid ethnographic assessmentexternal icon
Loosier PS, Carry M, Fasula A, Hatfield-Timajchy K, Jones SA, Harvill J, Smith T, McLaughlin J.
J Community Health. 2020 May 14.
Impact of community treatment with ivermectin for the control of scabies on the prevalence of antibodies to Strongyloides stercoralis in childrenexternal icon
Marks M, Gwyn S, Toloka H, Kositz C, Asugeni J, Asugeni R, Diau J, Kaldor JM, Romani L, Redman-MacLaren M, MacLaren D, Solomon AW, Mabey DC, Steer AC, Martin D.
Clin Infect Dis. 2020 May 18.
Estimating the catchment population and incidence of severe acute respiratory infections in a district hospital in Bousse, Burkina Fasoexternal icon
Milucky JL, Compaore T, Obulbiga F, Cowman G, Whitney CG, Bicaba B.
J Glob Health. 2020 Jun;10(1):010422.
Outbreak investigation of COVID-19 among residents and staff of an independent and assisted living community for older adults in Seattle, Washingtonexternal icon
Roxby AC, Greninger AL, Hatfield KM, Lynch JB, Dellit TH, James A, Taylor J, Page LC, Kimball A, Arons M, Munanga A, Stone N, Jernigan JA, Reddy SC, Lewis J, Cohen SA, Jerome KR, Duchin JS, Neme S.
JAMA Intern Med. 2020 May 21.
Feasibility of social distancing practices in US schools to reduce influenza transmission during a pandemicexternal icon
Uscher-Pines L, Schwartz HL, Ahmed F, Zheteyeva Y, Tamargo Leschitz J, Pillemer F, Faherty L, Uzicanin A.
J Public Health Manag Pract. 2020 Jul/Aug;26(4):357-370.
Evaluation of a program to improve linkage to and retention in care among refugees with hepatitis B virus infection - three U.S. cities, 2006-2018external icon
Young J, Payton C, Walker P, White D, Brandeland M, Kumar GS, Jentes ES, Settgast A, DeSilva M.
MMWR Morb Mortal Wkly Rep. 2020 May 29;69(21):647-650.
- Disaster Control and Emergency Services
Strategies for optimizing the supply of N95 filtering facepiece respirators during the coronavirus disease 2019 (COVID-19) pandemicexternal icon
de Perio MA, Dowell CH, Delaney LJ, Radonovich LJ, Kuhar D, Gupta N, Patel A, Pillai SK, D'Alessandro M.
Disaster Med Public Health Prep. 2020 May 19:1-23.
- Disease Reservoirs and Vectors
Unexpected rabies variant identified in kinkajou (Potos flavus), Mato Grosso, Brazilexternal icon
Dell'Armelina Rocha PR, Velasco-Villa A, de Lima EM, Salomoni A, Fusaro A, da Conceição Souza E, Negreiros RL, Zafino VL, Zamperin G, Leopardi S, Monne I, Benedictis P.
Emerg Microbes Infect. 2020 Dec;9(1):851-854.
Ecology and epidemiology of tickborne pathogens, Washington, USA, 2011-2016external icon
Dykstra EA, Oltean HN, Kangiser D, Marsden-Haug N, Rich SM, Xu G, Lee MK, Morshed MG, Graham CB, Eisen RJ.
Emerg Infect Dis. 2020 Apr;26(4):648-657.
- Environmental Health
Smoke alarms and carbon monoxide alarms in households with children, Puerto Rico, 2010external icon
Chen J, Dignam T, Yip F, Garcia BR, Blanton C, Brown MJ, Sircar K.
J Prim Prev. 2020 Jun;41(3):279-295.
Parental preconception and prenatal urinary bisphenol A and paraben concentrations and child behaviorexternal icon
Skarha J, Messerlian C, Bellinger D, Minguez-Alarcon L, Romano ME, Ford JB, Williams PL, Calafat AM, Hauser R, Braun JM.
Environ Epidemiol. 2020 .
- Epidemiology and Surveillance
Comparisons of estimates from the Behavioral Risk Factor Surveillance System and other national health surveys, 2011−2016external icon
Hsia J, Zhao G, Town M, Ren J, Okoro CA, Pierannunzi C, Garvin W.
Am J Prev Med. 2020 ;58(6):e181-e190.
- Food Safety
Retail deli characteristics associated with sanitizing solution concentrationsexternal icon
Holst M, Brown LG, Hoover ER, Julian E, Faw BV, Hedeen N, McKelvey W, Nicholas D, Ripley D, McKelvey W.
J Food Prot. 2020 May 18.
Restaurant policies and practices related to norovirus outbreak size and durationexternal icon
Hoover ER, Hedeen N, Freeland A, Kambhampati A, Dewey-Mattia D, Scott KW, Hall A, Brown LG.
J Food Prot. 2020 May 18.
Toxoplasmosis outbreak associated with Toxoplasma gondii-contaminated venison-high attack rate, unusual clinical presentation, and atypical genotypeexternal icon
Schumacher AC, Elbadawi LI, DeSalvo T, Straily A, Ajzenberg D, Letzer D, Moldenhauer E, Handly TL, Hill D, Darde ML, Pomares C, Passebosc-Faure K, Bisgard K, Gomez CA, Press C, Smiley S, Montoya JG, Kazmierczak JJ.
Clin Infect Dis. 2020 May 15.
- Health Disparities
Racial and ethnic differences in women's HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemicexternal icon
Willie TC, Kershaw TS, Blackstock O, Galvao RW, Safon CB, Tekeste M, Ogburn DF, Wilbourn B, Modrakovic D, Taggart T, Kaplan C, Caldwell A, Calabrese SK.
AIDS Care. 2020 May 14:1-10.
- Health Economics
Patient-provider discussions about out-of-pocket costs of cancer care in the U.Sexternal icon
Rai A, Zheng Z, Zhao J, de Moor JS, Ekwueme DU, Yabroff KR.
Am J Prev Med. 2020 May 14.
- Healthcare Associated Infections
A microbiological survey of handwashing sinks in the hospital built environment reveals differences in patient room and healthcare personnel sinksexternal icon
Franco LC, Tanner W, Ganim C, Davy T, Edwards J, Donlan R.
Sci Rep. 2020 May 19;10(1):8234.
High burden of bloodstream infections associated with antimicrobial resistance and mortality in the neonatal intensive care unit in Pune, Indiaexternal icon
Johnson J, Robinson ML, Rajput UC, Valvi C, Kinikar A, Parikh TB, Vaidya U, Malwade S, Agarkhedkar S, Randive B, Kadam A, Smith RM, Westercamp M, Mave V, Gupta A, Milstone AM, Manabe YC.
Clin Infect Dis. 2020 May 18.
- Immunity and Immunization
Centers for Disease Control and Prevention's School Vaccination Assessment: Collaboration with US state, local, and territorial immunization programs, 2012-2018external icon
Mellerson JL, Street E, Knighton C, Calhoun K, Seither R, Underwood JM.
Am J Public Health. 2020 May 21:e1-e6.
Increasing non-susceptibility to antibiotics within carried pneumococcal serotypes - Alaska, 2008-2015external icon
Plumb ID, Gounder PP, Bruden DJ, Bulkow LR, Rudolph KM, Singleton RJ, Hennessy TW, Bruce MG.
Vaccine. 2020 Jun 2;38(27):4273-4280.
Electronic immunization registers - a tool for mitigating outbreaks of vaccine-preventable diseases in the Pacificexternal icon
Sheel M, Tippins A, Glass K, Kirk M, Lau CL.
Vaccine. 2020 May 12.
Human monkeypox - after 40 years, an unintended consequence of smallpox eradicationexternal icon
Simpson K, Heymann D, Brown CS, Edmunds WJ, Elsgaard J, Fine P, Hochrein H, Hoff NA, Green A, Ihekweazu C, Jones TC, Lule S, Maclennan J, McCollum A, Muhlemann B, Nightingale E, Ogoina D, Ogunleye A, Petersen B, Powell J, Quantick O, Rimoin AW, Ulaeato D, Wapling A.
Vaccine. 2020 May 13.
- Injury and Violence
Use of sport-related concussion information sources among parents of United States middle school childrenexternal icon
Kerr ZY, Chandran A, Nedimyer AK, Rothschild AE, Kay MC, Gildner P, Byrd KH, Haarbauer-Krupa JK, Register-Mihalik JK.
J Sport Health Sci. 2020 May 14.
- Laboratory Sciences
Causes of fever in primary care in Southeast Asia and the performance of C-reactive protein in discriminating bacterial from viral pathogensexternal icon
Althaus T, Thaipadungpanit J, Greer RC, Swe MM, Dittrich S, Peerawaranun P, Smit PW, Wangrangsimakul T, Blacksell S, Winchell JM, Diaz MH, Day NP, Smithuis F, Turner P, Lubell Y.
Int J Infect Dis. 2020 May 10.
A new pneumococcal capsule type, 10D, is the 100th serotype and has a large cps fragment from an oral streptococcusexternal icon
Ganaie F, Saad JS, McGee L, van Tonder AJ, Bentley SD, Lo SW, Gladstone RA, Turner P, Keenan JD, Breiman RF, Nahm MH.
mBio. 2020 May 19;11(3).
Draft genome sequences of two extensively drug-resistant strains of Acinetobacter baumannii isolated from clinical samples in Pakistanexternal icon
Lomonaco S, Crawford MA, Lascols C, Fisher DJ, Anderson K, Hodge DR, Pillai SP, Morse SA, Khan E, Hughes MA, Allard MW, Sharma SK.
Microbiol Resour Announc. 2020 May 14;9(20).
A DNA polymerization-independent role for mitochondrial DNA polymerase I-like protein C in African trypanosomesexternal icon
Miller JC, Delzell SB, Concepcion-Acevedo J, Boucher MJ, Klingbeil MM.
J Cell Sci. 2020 May 7;133(9).
High resolution mass spectrometry newborn screening applications for quantitative analysis of amino acids and acylcarnitines from dried blood spotsexternal icon
Pickens CA, Petritis K.
Analytica Chimica Acta. 2020 .
Structure-guided optimization of inhibitors of acetyltransferase Eis from Mycobacterium tuberculosisexternal icon
Punetha A, Ngo HX, Holbrook SY, Green KD, Willby MJ, Bonnett SA, Krieger K, Dennis EK, Posey JE, Parish T, Tsodikov OV, Garneau-Tsodikova S.
ACS Chem Biol. 2020 May 18.
- Maternal and Child Health
Epidemiology of sudden death in a population-based study of infants and childrenexternal icon
Burns KM, Cottengim C, Dykstra H, Faulkner M, Erck Lambert AB, MacLeod H, Novak A, Parks SE, Russell MW, Shapiro-Mendoza CK, Shaw E, Tian N, Whittemore V, Kaltman JR.
Journal of Pediatrics: X. 2020 ;2.
Treatment discontinuation within 3 years of levothyroxine initiation among children diagnosed with congenital hypothyroidismexternal icon
Kemper AR, Grosse SD, Baker M, Pollock AJ, Hinton CF, Shapira SK.
J Pediatr. 2020 May 8.
Congenital CMV-coded diagnosis among American Indian and Alaska Native infants in the United States, 2000-2017external icon
Leung J, Kennedy JL, Haberling DL, Apostolou A, Lanzieri TM.
J Immigr Minor Health. 2020 May 18.
Etiology of prelingual hearing loss in the universal newborn hearing screening era: A scoping reviewexternal icon
Satterfield-Nash A, Umrigar A, Lanzieri TM.
Otolaryngol Head Neck Surg. 2020 May 19.
- Nutritional Sciences
Associations of health literacy and menu-labeling usage with sugar-sweetened beverage intake among adults in Mississippi, 2016external icon
Lee SH, Zhang L, Rubin DL, Park S.
Am J Health Promot. 2020 May 21.
- Occupational Safety and Health
Challenges and recommendations on the conduct of systematic reviews of observational epidemiologic studies in environmental and occupational healthexternal icon
Arroyave WD, Mehta SS, Guha N, Schwingl P, Taylor KW, Glenn B, Radke EG, Vilahur N, Carreon T, Nachman RM, Lunn RM.
J Expo Sci Environ Epidemiol. 2020 May 15.
The effect of blood glucose on quiet standing balance in young healthy individualsexternal icon
Breloff SP, Bachman JL, Lugade VA, Stuka AD.
Biomed Eng (Singapore). 2020 ;32(2).
Reducing ultrafine particulate emission from multiple 3D printers in an office environment using a prototype engineering controlexternal icon
Dunn KL, Hammond D, Menchaca K, Roth G, Dunn KH.
J Nanopart Res. 2020 ;22(5).
Effects of working posture and roof slope on activation of lower limb muscles during shingle installationexternal icon
Dutta A, Breloff SP, Dai F, Sinsel EW, Warren CM, Carey RE, Wu JZ.
Ergonomics. 2020 May 21:1-17.
Nurse health: The influence of chronotype and shift timingexternal icon
Hittle BM, Caruso CC, Jones HJ, Bhattacharya A, Lambert J, Gillespie GL.
West J Nurs Res. 2020 May 17.
- Parasitic Diseases
Evidence for treating malaria with artemisinin-based combination therapy in the first trimester of pregnancyexternal icon
Gutman JR, Chico RM.
Lancet Infect Dis. 2020 .
Notes from the field: Impact of a mass drug administration campaign using a novel three-drug regimen on lymphatic filariasis antigenemia - American Samoa, 2019external icon
Hast MA, Tufa A, Brant TA, Suiaunoa-Scanlan L, Camacho J, Vaifanua-Leo J, Robinson K, Dodd E, Sili B, Lees LS, Won KY, Utu F.
MMWR Morb Mortal Wkly Rep. 2020 May 29;69(21):656-657.
Malaria in the pregnant travelerexternal icon
McKinney KL, Wu HM, Tan KR, Gutman JR.
J Travel Med. 2020 May 18.
- Substance Use and Abuse
Demographics, substance use behaviors, and clinical characteristics of adolescents with e-cigarette, or vaping, product use-associated lung injury (EVALI) in the United States in 2019external icon
Adkins SH, Anderson KN, Goodman AB, Twentyman E, Danielson ML, Kimball A, Click ES, Ko JY, Evans ME, Weissman DN, Melstrom P, Kiernan E, Krishnasamy V, Rose DA, Jones CM, King BA, Ellington SR, Pollack LA, Wiltz JL.
JAMA Pediatr. 2020 May 18:e200756.
Opioid prescribing history prior to heroin overdose among commercially insured adultsexternal icon
Lagisetty P, Zhang K, Haffajee RL, Lin LA, Goldstick J, Brownlee R, Bohnert A, Larochelle MR.
Drug Alcohol Depend. 2020 May 12;212:108061.
Tobacco use by pregnant Medicaid beneficiaries: Validating a claims-based measure in Oregonexternal icon
Luck J, Larson AE, Tong VT, Yoon J, Oakley LP, Harvey SM.
Prev Med Rep. 2020 Sep;19:101039.
Adolescent opioid misuse attributable to adverse childhood experiencesexternal icon
Swedo EA, Sumner SA, de Fijter S, Werhan L, Norris K, Beauregard JL, Montgomery MP, Rose EB, Hillis SD, Massetti GM.
J Pediatr. 2020 May 10.
- Zoonotic and Vectorborne Diseases
Barriers to attendance of canine rabies vaccination campaigns in Haiti, 2017external icon
Barbosa Costa G, Ludder F, Monroe B, Dilius P, Crowdis K, Blanton JD, Pieracci EG, Head JR, Gibson AD, Wallace RM.
Transbound Emerg Dis. 2020 May 21.
Brucellosis knowledge, attitudes and practices of a South African communal cattle keeper groupexternal icon
Cloete A, Gerstenberg C, Mayet N, Tempia S.
Onderstepoort J Vet Res. 2019 Feb 18;86(1):e1-e10.
Etiology of microcephaly and central nervous system defects during the Zika epidemic in Colombiaexternal icon
Galang RR, Avila GA, Valencia D, Daza M, Tong VT, Bermudez AJ, Gilboa SM, Rico A, Cates J, Pacheco O, Winfield CM, Prieto F, Honein MA, Cortes LJ, Moore CA, Ospina ML.
J Pediatr. 2020 May 13.
Evidence of behaviour change during an Ebola virus disease outbreak, Sierra Leonepdf iconexternal icon
Jalloh MF, Sengeh P, Bunnell RE, Jalloh MB, Monasch R, Li W, Mermin J, Deluca N, Brown V, Nur SA, August EM, Ransom RL, Namageyo-Funa A, Clements SA, Dyson M, Hageman K, Pratt SA, Nuriddin A, Carroll DD, Hawk N, Manning C, Hersey S, Marston BJ, Kilmarx PH, Conteh L, Ekström AM, Zeebari Z, Redd JT, Nordenstedt H, Morgan O.
Bull World Health Organ. 2020 ;98(5):330-340B.
A framework for coordination between obstetric and pediatric providers in public health emergencies: Lessons learned from the Zika outbreak in the United States, 2015 to 2017external icon
Leeb RT, Cree RA, Aird L, DeBiasi RL, Driggers RW, Garbarczyk E, Mofenson LM, Needle S, Rodriguez J, Curry C, Garcia F, Godfred-Cato S, Hawks D, Rosenblum E, Dziuban E, Hudak M.
Am J Perinatol. 2020 May 21.
Immunologic timeline of Ebola virus disease and recovery in humansexternal icon
McElroy AK, Akondy RS, McLlwain DR, Chen H, Bjornson-Hooper Z, Mukherjee N, Mehta AK, Nolan G, Nichol ST, Spiropoulou CF.
JCI Insight. 2020 May 21;5(10).
Adaptation of H9N2 influenza viruses to mammalian hosts: A review of molecular markersexternal icon
Sun X, Belser JA, Maines TR.
Viruses. 2020 May 14;12(5).
- Chronic Diseases and Conditions
CDC Science Clips Production Staff
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- Gail Bang, MLIS, Librarian
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DISCLAIMER: Articles listed in the CDC Science Clips are selected by the Stephen B. Thacker CDC Library to provide current awareness of the public health literature. An article's inclusion does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article's methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.