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Issue 8, February 21, 2023

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CDC Science Clips: Volume 15, Issue 8, February 21, 2023

Science Clips is produced weekly to enhance awareness of emerging scientific knowledge for the public health community. Each article features an Altmetric Attention score to track social and mainstream media mentions.

The report consists of these components:

  1. 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
      1. Association of elevated arterial stiffness with cardiac target organ damage and cardiac autonomic neuropathy in young adults with diabetes: The SEARCH for Diabetes in Youth Study
        Urbina EM, Isom S, Dabelea D, D'Agostino R, Daniels SR, Dolan LM, Imperatore G, Lustigova E, Marcovina S, Mottl A, Pihoker C, Shah AS.
        Diabetes Care. 2023 02/21/2023.
        OBJECTIVE: Adults with diabetes are at risk for cardiovascular (CV) events, possibly due to increased arterial stiffness (AS) and cardiac autonomic neuropathy (CAN). We sought to determine whether 1) AS is associated with cardiac target organ damage in young adults with youth-onset diabetes, 2) whether CAN is associated with AS, as one possible etiology for increased AS in this cohort, and 3) whether these relationships differ by type of diabetes. RESEARCH DESIGN AND METHODS: Participants from the SEARCH for Diabetes in Youth Study (type 1 diabetes [T1D], n = 222; type 2 diabetes [T2D], n = 177; mean age 23 years) had clinical, echocardiographic, AS, and CAN assessed. Linear regression was performed to determine whether AS was associated with cardiac changes and CAN and whether relationships differed by diabetes type. RESULTS: AS was significantly associated with cardiac structure (left ventricular mass index, P < 0.0001), systolic function (ejection fraction, P = 0.03) and diastolic function (transmitral peak early [E]/atrial [A] wave velocities ratio, P = 0.008; early [e']/atrial [a'] waves, P = 0.02) after adjustments for CV risk factors. The association between AS and CAN was not significant when other important covariates were added. These relationships were mostly similar in both T1D and T2D. CONCLUSIONS: AS is associated with cardiac changes in young adults with diabetes. CAN-induced AS does not appear to be an etiology for cardiac abnormalities in this cohort.

        Imperatore, G.

      2. Post-COVID conditions and healthcare utilization among adults with and without disabilities-2021 Porter Novelli Fall Styles survey
        Miller MJ, Feldstein LR, Holbrook J, Plumb ID, Accorsi EK, Zhang QC, Cheng Q, Ko JY, Wanga V, Konkle S, Dimitrov LV, Bertolli J, Saydah S.
        Disabil Health J. 2022 02/21/2023:101436.
        BACKGROUND: Adults with disabilities are at increased risk for SARS-CoV-2 infection and severe disease; whether adults with disabilities are at an increased risk for ongoing symptoms after acute SARS-CoV-2 infection is unknown. OBJECTIVES: To estimate the frequency and duration of long-term symptoms (>4 weeks) and health care utilization among adults with and without disabilities who self-report positive or negative SARS-CoV-2 test results. METHODS: Data from a nationwide survey of 4510 U.S. adults administered from September 24, 2021-October 7, 2021, were analyzed for 3251 (79%) participants who self-reported disability status, symptom(s), and SARS-CoV-2 test results (a positive test or only negative tests). Multivariable models were used to estimate the odds of having ≥1 COVID-19-like symptom(s) lasting >4 weeks by test result and disability status, weighted and adjusted for socio-demographics. RESULTS: Respondents who tested positive for SARS-CoV-2 had higher odds of reporting ≥1 long-term symptom (with disability: aOR = 4.50 [95% CI: 2.37, 8.54] and without disability: aOR = 9.88 [95% CI: 7.13, 13.71]) compared to respondents testing negative. Among respondents who tested positive, those with disabilities were not significantly more likely to experience long-term symptoms compared to respondents without disabilities (aOR = 1.65 [95% CI: 0.78, 3.50]). Health care utilization for reported symptoms was higher among respondents with disabilities who tested positive (40%) than among respondents without disabilities who tested positive (18%). CONCLUSIONS: Ongoing symptoms among adults with and without disabilities who also test positive for SARS-CoV-2 are common; however, the frequency of health care utilization for ongoing symptoms is two-fold among adults with disabilities.

        Miller, M. J. | Feldstein, L. R. | Holbrook, J. | Plumb, I. D. | Accorsi, E. K. | Zhang, Q. C. | Cheng, Q. | Ko, J. Y. | Wanga, V. | Konkle, S. | Dimitrov, L. V. | Bertolli, J. | Saydah, S.

      3. Acute cardiac events during COVID-19-associated hospitalizations
        Woodruff RC, Garg S, George MG, Patel K, Jackson SL, Loustalot F, Wortham JM, Taylor CA, Whitaker M, Reingold A, Alden NB, Meek J, Anderson EJ, Weigel A, Henderson J, Bye E, Davis SS, Barney G, Bennett NM, Shiltz E, Sutton M, Talbot HK, Price A, Sperling LS, Havers FP.
        J Am Coll Cardiol. 2023 02/21/2023;81(6):557-569.
        BACKGROUND: COVID-19 is associated with cardiac complications. OBJECTIVES: The purpose of this study was to estimate the prevalence, risk factors, and outcomes associated with acute cardiac events during COVID-19-associated hospitalizations among adults. METHODS: During January 2021 to November 2021, medical chart abstraction was conducted on a probability sample of adults hospitalized with laboratory-confirmed SARS-CoV-2 infection identified from 99 U.S. counties in 14 U.S. states in the COVID-19-Associated Hospitalization Surveillance Network. We calculated the prevalence of acute cardiac events (identified by International Classification of Diseases-10th Revision-Clinical Modification codes) by history of underlying cardiac disease and examined associated risk factors and disease outcomes. RESULTS: Among 8,460 adults, 11.4% (95% CI: 10.1%-12.9%) experienced an acute cardiac event during a COVID-19-associated hospitalization. Prevalence was higher among adults who had underlying cardiac disease (23.4%; 95% CI: 20.7%-26.3%) compared with those who did not (6.2%; 95% CI: 5.1%-7.6%). Acute ischemic heart disease (5.5%; 95% CI: 4.5%-6.5%) and acute heart failure (5.4%; 95% CI: 4.4%-6.6%) were the most prevalent events; 0.3% (95% CI: 0.1%-0.5%) experienced acute myocarditis or pericarditis. Risk factors varied by underlying cardiac disease status. Patients with ≥1 acute cardiac event had greater risk of intensive care unit admission (adjusted risk ratio: 1.9; 95% CI: 1.8-2.1) and in-hospital death (adjusted risk ratio: 1.7; 95% CI: 1.3-2.1) compared with those who did not. CONCLUSIONS: Acute cardiac events were common during COVID-19-associated hospitalizations, particularly among patients with underlying cardiac disease, and are associated with severe disease outcomes. Persons at greater risk for experiencing acute cardiac events during COVID-19-associated hospitalizations might benefit from more intensive clinical evaluation and monitoring during hospitalization.

        Woodruff, R. C. Garg, S. George, M. G. Patel, K. Jackson, S. L. Loustalot, F. Wortham, J. M. Taylor, C. A. Whitaker, M. Sperling, L. S. Havers, F. P.

    • Communicable Diseases
      1. Providing HIV pre-exposure prophylaxis to men who have sex with men and transgender women in hospitals and community-led clinics in Thailand: acceptance, patterns of use, trends in risk behaviors, and HIV incidence
        Cheewanan l, Chomnad M, Nittaya P, Deondara T, Thana K, Tharee P, Supabhorn P, Patcharaporn P, Prin V, Surang J, Danai L, Thitiyanun N, Nuchapong J, Michael M.
        AIDS Care. 2023 02/21/2023:1-14.
        From May 2015 to June 2018, we conducted a PrEP demonstration project at two hospitals and four community-led clinics in Bangkok and Pattaya. HIV-negative, MSM and TGW aged ≥18 years old, reporting sex without a condom, were offered daily PrEP. Participants received HIV testing and completed a computer-based questionnaire at enrollment, 6 and 12 months. We collected self-reported PrEP adherence at months 1, 3, 6, 9, and 12. We used logistic regression to determine factors associated with the decision to take PrEP and calculated HIV incidence among baseline HIV-negative participants. Of 803 participants enrolled, 349 (43.5%) started PrEP. Participants were more likely to start PrEP if they were sex workers, had moderate or high self-perceived risk of HIV, or a high PrEP-knowledge score. Participants used PrEP for a median of 6.1 months. Reported condom use increased and the number of sex partners decreased during follow-up regardless of PrEP use. Six participants not-taking PrEP acquired HIV (HIV incidence 2.2 per 100 person-years), and five taking PrEP acquired HIV (HIV incidence 2.1 per 100 person-years). All five reported taking <4 pills the weeks before study visits.

        Chomnad, M. Prin, V. Nuchapong, J. Michael, M.

      2. Presence of symptoms 6 weeks after COVID-19 among vaccinated and unvaccinated US healthcare personnel: a prospective cohort study
        Mohr NM, Plumb ID, Harland KK, Pilishvili T, Fleming-Dutra KE, Krishnadasan A, Hoth KF, Saydah SH, Mankoff Z, Haran JP, Briggs-Hagen M, León ES, Talan DA.
        BMJ Open. 2023 02/21/2023;13(2):e063141.
        OBJECTIVES: Although COVID-19 vaccines offer protection against infection and severe disease, there is limited information on the effect of vaccination on prolonged symptoms following COVID-19. Our objective was to determine differences in prevalence of prolonged symptoms 6 weeks after onset of COVID-19 among healthcare personnel (HCP) by vaccination status, and to assess differences in timing of return to work. DESIGN: Cohort analysis of HCP with COVID-19 enrolled in a multicentre vaccine effectiveness study. HCP with COVID-19 between December 2020 and August 2021 were followed up 6 weeks after illness onset. SETTING: Health systems in 12 US states. PARTICIPANTS: HCP participating in a vaccine effectiveness study were eligible for inclusion if they had laboratory-confirmed symptomatic SARS-CoV-2 with mRNA vaccination (symptom onset ≥14 days after two doses) or no prior vaccination. Among 681 eligible participants, 419 (61%) completed a follow-up survey to assess symptoms reported 6 weeks after illness onset. EXPOSURES: Two doses of a COVID-19 mRNA vaccine compared with no COVID-19 vaccine. MAIN OUTCOME MEASURES: Prevalence of symptoms 6 weeks after onset of COVID-19 illness and days to return to work. RESULTS: Among 419 HCP with COVID-19, 298 (71%) reported one or more COVID-like symptoms 6 weeks after illness onset, with a lower prevalence among vaccinated participants compared with unvaccinated participants (60.6% vs 79.1%; adjusted risk ratio 0.70, 95% CI 0.58 to 0.84). Following their illness, vaccinated HCP returned to work a median 2.0 days (95% CI 1.0 to 3.0) sooner than unvaccinated HCP (adjusted HR 1.37, 95% CI 1.04 to 1.79). CONCLUSIONS: Receipt of two doses of a COVID-19 mRNA vaccine among HCP with COVID-19 illness was associated with decreased prevalence of COVID-like symptoms at 6 weeks and earlier return to work.

        Plumb, I. D. Pilishvili, T. Fleming-Dutra, K. E. Saydah, S. H. Briggs-Hagen, M.

      3. Pharmacology of boosted and unboosted integrase strand transfer inhibitors for two-dose event-driven HIV prevention regimens among men
        Haaland RE, Fountain J, Martin A, Dinh C, Holder A, Edwards TE, Lupo LD, Hall L, Conway-Washington C, Massud I, García-Lerma JG, Kelley CF, Heneine WM.
        J Antimicrob Chemother. 2023 02/21/2023;78(2):497-503.
        BACKGROUND: Event-driven HIV prevention strategies are a priority for users who do not require daily pre-exposure prophylaxis (PrEP). Regimens containing integrase strand transfer inhibitors (INSTIs) are under evaluation as alternatives to daily PrEP. To better understand INSTI distribution and inform dosing selection we compared the pharmacology of two-dose boosted elvitegravir and unboosted bictegravir regimens in MSM. MATERIALS AND METHODS: Blood, rectal and penile secretions and rectal biopsies were collected from 63 HIV-negative MSM aged 18-49 years. Specimens were collected up to 96 h after two oral doses of tenofovir alafenamide and emtricitabine with elvitegravir boosted by cobicistat or unboosted bictegravir given 24 h apart. Antiretroviral drugs were measured by LC-MS. RESULTS: Mean bictegravir plasma concentrations remained above the 95% protein-adjusted effective concentration 96 h after dosing [273 (95% CI: 164-456) ng/mL] whereas elvitegravir plasma concentrations became undetectable 48 h after the second dose. Bictegravir and elvitegravir reached rectal tissues within 2 h after the first dose, and elvitegravir tissue concentrations [1.07 (0.38-13.51) ng/mg] were greater than bictegravir concentrations [0.27 (0.15-0.70) ng/mg]. Both INSTIs became undetectable in tissues within 96 h. Elvitegravir and bictegravir were not consistently detected in penile secretions. CONCLUSIONS: Whereas bictegravir plasma concentrations persist at least 4 days after a two-oral-dose HIV prophylaxis regimen, elvitegravir accumulates in mucosal tissues. Differing elvitegravir and bictegravir distribution may result in variable mucosal and systemic antiviral activity and can inform dosing strategies for event-driven HIV prevention.

        Haaland, R. E. Fountain, J. Martin, A. Dinh, C. Holder, A. Edwards, T. E. Lupo, L. D. Massud, I. García-Lerma, J. G. Heneine, W. M.

      4. Information for persons who are immunocompromised regarding prevention and treatment of SARS-CoV-2 infection in the context of currently circulating Omicron sublineages - United States, January 2023
        Patel P, Twentyman E, Koumans E, Rosenblum H, Griffin-Blake S, Jackson B, Vagi S.
        MMWR Morb Mortal Wkly Rep. 2023 02/21/2023;72(5):128-131.
        As of January 20, 2023, >90% of circulating SARS-CoV-2 variants in the United States, specifically Omicron BQ.1, BQ.1.1, XBB, and XBB.1.5 sublineages, are unlikely to be susceptible to the combined monoclonal antibodies, tixagevimab and cilgavimab (Evusheld) used for preexposure prophylaxis against SARS-CoV-2 infection (1). The Food and Drug Administration announced on January 26, 2023, that Evusheld is not currently authorized for preexposure prophylaxis against SARS-CoV-2 infection in the United States (2). It is important that persons who are moderately to severely immunocompromised,* those who might have an inadequate immune response to COVID-19 vaccination, and those with contraindications to receipt of COVID-19 vaccines, exercise caution and recognize the need for additional preventive measures (Box). In addition, persons should have a care plan that includes prompt testing at the onset of COVID-19 symptoms and rapid access to antivirals if SARS-CoV-2 infection is detected.

        Patel, P. Twentyman, E. Koumans, E. Rosenblum, H. Griffin-Blake, S. Jackson, B. Vagi, S.

      5. Multiple MIS-C readmissions and giant coronary aneurysm after COVID-19 illness and vaccination: A case report
        Haq K, Anyalechi EG, Schlaudecker EP, McKay R, Kamidani S, Manos CK, Oster ME.
        Pediatr Infect Dis J. 2022 02/21/2023.
        BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) rarely involves delayed giant coronary aneurysms, multiple readmissions or occurrence after COVID-19 vaccination. METHODS: We describe a child with all 3 of these unusual features. We discuss his clinical presentation, medical management, review of the current literature and CDC guidance recommendations regarding further vaccinations. RESULTS: A 5-year-old boy had onset of MIS-C symptoms 55 days after COVID-19 illness and 15 days after receiving his first BNT162b2 COVID-19 vaccination. He was admitted 3 times for MIS-C, and twice after his steroid dose was tapered. On his initial admission, he was given intravenous immunoglobulin and steroids. During his second admission, new, moderate coronary dilation was noted, and he was treated with intravenous immunoglobulin and steroids. At his last admission, worsening coronary dilation was noted, and he was treated with infliximab and steroids. During follow-up, he had improvement in his coronary artery dilatation. However, his inflammatory markers increased after steroid wean, and his steroid taper was further extended, after which time his inflammatory markers improved. This is the only such reported case of a patient who was admitted 3 times for MIS-C complications after COVID-19 vaccination. CONCLUSION: MIS-C rarely involves delayed giant coronary aneurysms, multiple readmissions, or occurrence after COVID-19 vaccination. Whether our patient's COVID-19 vaccine 6 weeks after COVID-19 illness contributed to his MIS-C is unknown. After consultation with the CDC-funded Clinical Immunization Safety Assessment Project, the patient's care team decided against further COVID-19 vaccination until at least 3 months post normalization of inflammatory markers.

        Anyalechi, E. G. Oster, M. E.

      6. HIV viral load scale-up among children and adolescents: Trends in viral load suppression, sample type and processing in 7 PEPFAR countries, 2015-2018
        Hrapcak S, Pals S, Itoh M, Peters N, Carpenter D, Hackett S, Prao AK, Adje-Toure C, Eboi E, Mutisya I, Nyabiage Omoto L, Ondondo RO, Bowen N, Nyanya W, Kayira D, Kaba MD, Mwenda R, Deus MI, Almeida J, Cuco RM, Boylan A, Beard S, Ashikoto S, van Rooyen G, Kindra G, Diallo K, Carmona S, Nazziwa E, Mwangi C, Ntale J, Ssewanyana I, Nabadda SN, Nabukenya M, Ellenberger D, Rivadeneira E.
        Pediatr Infect Dis J. 2023 02/21/2023.
        HIV-positive children and adolescents face gaps in viral load (VL) testing. To understand trends in pediatric/adolescent VL testing, 7 countries collected data from Laboratory Information Management Systems. Results showed increasing proportion of VL tests done through dried blood spot (DBS) and decreased sample rejection rates for DBS compared with plasma, supporting use of DBS VL when skilled phlebotomy is unavailable.

        Hrapcak, S. Pals, S. Itoh, M. Carpenter, D. Hackett, S. Eboi, E. Beard, S. Kindra, G. Diallo, K. Nazziwa, E. Mwangi, C. Ntale, J. Ellenberger, D. Rivadeneira, E.

      7. Investigation of SARS-CoV-2 transmission in the Tabernacle Choir at Temple Square in the context of prevention protocols, Utah, September-November 2021
        Lanier WA, Palmer DK, Willmore DK, Oakeson KF, Young EL, Nolen LD.
        Public Health Rep. 2023 02/21/2023:333549231152198.
        Group singing and playing of wind instruments increase COVID-19 transmission risk. After a pause during the initial period of the COVID-19 pandemic, The Tabernacle Choir at Temple Square organization (hereinafter, Choir) resumed musical events in September 2021 with prevention protocols, including required vaccination and pre-event rapid antigen testing. We investigated potential SARS-CoV-2 transmission at Choir events during September 21-November 7, 2021. We interviewed COVID-19-positive members (hereinafter, case-members) and identified members exposed when a case-member attended a Choir event during his or her infectious period. We compared whole genome sequencing results to assess the genetic relatedness of available SARS-CoV-2 specimens obtained from case-members. We identified 30 case-members through pre-event testing (n = 10), self-reported positive test results (n = 18), and a review of Utah's disease surveillance system (n = 2). All 30 case-members reported symptoms; 21 (70%) were women and 23 (77%) received a positive test result by nucleic acid amplification test. No hospitalizations or deaths were reported. We identified 176 test-eligible exposed members from 14 instances of case-members attending events during their infectious periods. All were tested at least once 2 to 14 days after exposure: 74 (42%) by rapid antigen test only (all negative) and 102 (58%) by nucleic acid amplification test (4 positive, 97 negative, and 1 equivocal). Among viral sequences available from 15 case-members, the smallest single-nucleotide polymorphism distance between 2 sequences was 2, and the next-smallest distance was 10. The lack of disease detected in most exposed members suggests that minimal, if any, transmission occurred at Choir events. When community COVID-19 incidence is high, prevention protocols might help limit SARS-CoV-2 transmission during group musical activities.

        Lanier, W. A.

      8. BACKGROUND: With potential impact of the COVID-19 pandemic on HIV PrEP care management, we assessed the number of PrEP users and STI-testing-eligible PrEP users, STI testing rates and prevalence between pre-pandemic (01/01/2018-03/31/2020) and early-pandemic (04/01/2020-09/30/2020) periods. METHODS: In this retrospective cohort study, a PrEP user for a given quarter is defined as either a previous PrEP user or a PrEP initiator who has at least one day coverage of TDF/FTC in the given quarter. The STI-testing-eligible PrEP users for a given quarter were defined as those persons whose runout date (previous dispense date + days of TDF/FTC supply) was in the given quarter. RESULTS: The quarterly number of PrEP users increased from the 1st quarter of 2018 to the 1st quarter of 2020 and then decreased in the 2nd and 3rd quarter of 2020. Among STI-testing-eligible PrEP users who had ≤14 days between runout and next refill date, gonorrhea and chlamydia screening testing rates were 95.1% for pre-pandemic and 93.4% for early-pandemic (p = 0.1011). Among all STI-testing-eligible PrEP users who were tested for gonorrhea and chlamydia, gonorrhea prevalence was 6.7% for pre-pandemic and 5.7% for early-pandemic (p = 0.3096) and chlamydia prevalence was 7.0% for pre-pandemic and 5.8% for early-pandemic (p = 0.2158). CONCLUSIONS: Although the early COVID-19 pandemic resulted in lower numbers of PrEP users and PrEP initiators, individuals who remained continuous users of PrEP maintained extremely high rates of bacterial STI screening. With high STI prevalence among PrEP users, assessments of PrEP care management are continuously needed.

        Gift, T. L. Tao, G.

    • Community Health Services
      1. HIV testing preferences and characteristics of those who have never tested for HIV in the United States
        Patel SN, Emerson BP, Pitasi MA, Tripp NE, Marcus R, Delaney KP, Chavez PR.
        Sex Transm Dis. 2023 02/21/2023;50(3):175-179.
        BACKGROUND: The initial phase of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative prioritized efforts in 57 geographic areas. The US Centers for Disease Control and Prevention recommends persons aged 13 to 64 years be tested for HIV at least once as part of routine health care; however, it is unclear how effectively these testing recommendations have been implemented in EHE priority areas. METHODS: In 2021 to 2022, we analyzed data from a Web-based, nationally representative survey of adults fielded in 2021. HIV testing preferences were compared by testing history, demographic characteristics, behaviors, and geography. RESULTS: An estimated 72.5% of US adults had never tested for HIV. Never testing was most prevalent among those aged 18 to 29 or those 50 years or older, non-Hispanic White persons, and those living in the Midwest. Among persons living in EHE priority areas and persons reporting at least one behavior that increases risk of HIV transmission, 69.1% and 48.0%, respectively, had never tested for HIV. The top 3 HIV testing preferences among never testers were as follows: testing for HIV during a routine health care visit (41.2%), testing at an urgent care or walk-in clinic (9.6%), and self-testing (8.1%). CONCLUSIONS: Most adults had not been tested for HIV, confirming that US Centers for Disease Control and Prevention recommendations are not being fully implemented, even in EHE priority areas. Moreover, most adults who never tested preferred testing in clinical settings, highlighting missed opportunities. As the EHE initiative continues to advance, it is critical to leverage preferred HIV testing modalities, such as routine testing in clinical settings or HIV self-testing.

        Patel, S. N. | Emerson, B. P. | Pitasi, M. A. | Marcus, R. | Delaney, K. P. | Chavez, P. R.

    • Environmental Health
      1. World Trade Center Health Program best practices for the diagnosis and treatment of gastroesophageal reflux disease
        Lin RA, Calvert GM, Udasin IG.
        Arch Environ Occup Health. 2023 02/21/2023:1-5.
        Gastroesophageal reflux disease (GERD) is one of the most common health conditions reported among persons exposed to the dust, debris and chemicals after the September 11, 2001 attacks in the United States. In the 9/11-exposed population, GERD is often found to be co-morbid with other conditions, such as asthma, post-traumatic stress disorder, and obesity. High-quality clinical practice guidelines for GERD are available from the American College of Gastroenterology. GERD diagnostic services and medically necessary treatment are covered by the WTC Health Program for persons who meet eligibility criteria.

        Calvert, G. M.

      2. Temporal variation in indoor radon concentrations using environmental public health tracking data
        Manono Fotso Kamgang SL, Monti MM, Salame-Alfie A.
        Health Phys. 2023 02/21/2023.
        Indoor radon is the second leading cause of lung cancer in the United States (US) after smoking and the number one for lung cancer in non-smokers. Understanding how indoor radon varies during the year reveals the best time to test to avoid underestimating exposure. This study looks at the temporal variation in 13 years of radon concentrations in buildings located in 46 US states and the District of Columbia (DC). In the dataset, radon concentration varies from 3.7 Bq m-3 (Becquerels per cubic meter) to 52,958.1 Bq m-3, with an overall mean of 181.4 Bq m-3. About 35.4% of tests have a radon concentration level equal to or greater than the US Environmental Protection Agency (US EPA) action level 4.0 pCi L-1 (148 Bq m-3).3 Temporal variation in radon concentrations was assessed using the overall monthly mean radon concentration. The highest concentrations were found in January (203.8 Bq m-3) and the lowest in July (129.5 Bq m-3). Higher monthly mean indoor radon concentrations were found in January, February, and October, and lower in July, August, and June. This result is consistent with findings from other studies and suggests continuing to encourage radon testing throughout the year with an emphasis on testing during the colder months.

        Manono Fotso Kamgang, S. L. Monti, M. M. Salame-Alfie, A.

      3. Radon outreach: Helping people see an invisible risk
        Lutfy C, Salame-Alfie A, McCurley MC.
        J Environ Health. 2023 02/21/2023;85(6):30-33.

    • Genetics and Genomics
      1. ICTV virus taxonomy profile: Matonaviridae 2022
        Mankertz A, Chen MH, Goldberg TL, Hübschen JM, Pfaff F, Ulrich RG, Ictv Report C.
        J Gen Virol. 2022 02/21/2023;103(12).
        The family Matonaviridae comprises enveloped viruses with positive-sense RNA genomes of 9.6-10 kb. The genus Rubivirus includes rubella virus (species Rubivirus rubellae) infecting humans, ruhugu virus (species Rubivirus ruteetense) infecting bats and rustrela virus (species Rubivirus strelense) infecting rodents and zoo animals. Rubella virus is spread via droplets. Postnatal infection leads to benign disease with rash and fever. Infection of seronegative women with rubella virus during the first trimester of pregnancy will often result in severe foetal malformations, known as congenital rubella syndrome. Vaccines are globally available. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Matonaviridae, which is available at ictv.global/report/matonaviridae.

        Chen, M. H.

    • Health Behavior and Risk
      1. Trends in engagement with CDC's coronavirus self-checker and guidance provided to users in the United States between March 23, 2020 - April 19, 2021
        Shah AB, Oyegun E, Hampton WB, Neri AJ, Maddox N, Raso D, Sandhu P, Patel A, Koonin LM, Lee L, Roper L, Whitfield GP, Siegel DA, Koumans EH.
        J Med Internet Res. 2022 02/21/2023.
        BACKGROUND: In 2020, at the onset of the COVID-19 pandemic, the United States experienced surges in healthcare needs which challenged capacity throughout the healthcare system. Stay-at-home orders in many jurisdictions, cancellation of elective procedures, and closures of outpatient medical offices disrupted patient access to care. To inform symptomatic persons about when to seek care and potentially help alleviate the burden on the healthcare system, the Centers for Disease Control and Prevention (CDC) and partners developed the CDC Coronavirus Self-Checker ("Self-Checker"). This interactive tool assists individuals seeking information about COVID-19 to determine the appropriate level of care by asking demographic, clinical, and non-clinical questions during an online "conversation." OBJECTIVE: This paper describes user characteristics, trends in use, and recommendations delivered by the Self-Checker between March 23, 2020 and April 19,2021, for pursuing appropriate levels of medical care, depending on the severity of user symptoms. METHODS: User characteristics and trends in completed conversations that resulted in a care message were analyzed. Care messages delivered by the Self-Checker were manually classified into three overarching conversation themes: 1) seek care immediately; 2) take no action, or stay home and self-monitor; and 3) conversation redirected. Trends in 7-day averages of conversations and COVID-19 cases were examined with development and marketing milestones that potentially impacted Self-Checker user engagement. RESULTS: Among 16,718,667 completed conversations, the Self-Checker delivered recommendations for 69.3% of all conversations to "take no action, or stay home and self- monitor," 28.8% of conversations to "seek care immediately," and 1.9% of conversations were redirected to other resources without providing any care advice. Among 6.8 million conversations initiated for self-reported sick individuals without life-threatening symptoms, 59.21% resulted in a recommendation to "take no action, or stay home and self-monitor." Nearly all individuals (99.8%) who were not sick were also advised to "take no action, or stay home and self-monitor." CONCLUSIONS: The majority of Self-Checker conversations resulted in advice to take no action, or stay home and self-monitor. This guidance may have reduced patient volume on the medical system, but future studies evaluating patients' satisfaction, intention to follow care advice received, course of action and care modality pursued could clarify the impact of the Self-Checker and similar tools during future public health emergencies.

        Oyegun, E. Neri, A. J. Sandhu, P. Patel, A. Lee, L. Roper, L. Whitfield, G. P. Siegel, D. A. Koumans, E. H.

    • Health Communication and Education
      1. (Mis)perception and use of unsterile water in home medical devices, PN View 360+ Survey, United States, August 2021(1)
        Miko S, Collier SA, Burns-Lynch CE, Andújar AA, Benedict KM, Haston JC, Hough CO, Cope JR.
        Emerg Infect Dis. 2023 02/21/2023;29(2):397-401.
        Tap water is not sterile, and its use in home medical devices can result in infections from waterborne pathogens. However, many participants in a recent survey in the United States said tap water could safely be used for home medical devices. These results can inform communication materials to reduce the high consequence of infections.

        Miko, S. Collier, S. A. Burns-Lynch, C. E. Andújar, A. A. Benedict, K. M. Haston, J. C. Hough, C. O. Cope, J. R.

    • Health Equity and Health Disparities
      1. This systematic review synthesized published literature (January 2008-October 2021) about the association between social determinants of health (SDOH) and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM), a group disproportionally affected by HIV. Having higher education than a high school diploma, health insurance and access to health care services, and visiting a health care provider in the past 12 months were some of the determinants associated with HIV testing, while limited English proficiency was associated with reduced odds of HIV-testing among HLMSM. More research is needed to understand the relationship of SDOH (especially neighborhood) and HIV testing, how SDOH may affect HIV testing among different HLMSM groups, and how to increase self-testing and use of e-health in this priority population. Additionally, culturally and linguistically appropriate multilevel interventions and health services for HLMSM are urgently needed to diagnose HIV as early as possible after infection.

        Crepaz, N. Salabarría-Peña, Y. Mullins, M. M. Gunn, J. K. L. Higa, D. H.

      2. Multisystem inflammatory syndrome in American Indian/Alaska Native children, March 2020-May 2022
        Bornstein ER, Miller AD, Zambrano LD, Yousaf AR, Apostolou A, Weiser T, Campbell AP.
        Pediatr Infect Dis J. 2022 02/21/2023.
        We describe characteristics, clinical features and outcomes of multisystem inflammatory syndrome in children among American Indian and Alaska Native (AI/AN) persons compared with non-Hispanic white persons. AI/AN patients with multisystem inflammatory syndrome in children were younger, more often obese, and from areas of higher social vulnerability. A greater proportion of AI/AN patients had severe respiratory involvement and shock.

        Bornstein, E. R. | Miller, A. D. | Zambrano, L. D. | Yousaf, A. R. | Campbell, A. P.

      3. Racial disparities in severe maternal morbidity in an integrated health care system, Southern California, 2008-2017
        Oakley LP, Li X, Tartof SY, Wilkes-Grundy M, Fassett MJ, Lawrence JM.
        Womens Health Issues. 2023 02/21/2023.
        OBJECTIVE: The study's objectives were to examine rates of severe maternal morbidity (SMM) over a 10-year period and assess racial/ethnic disparities in SMM among insured women in a large, integrated health care system in Southern California. METHODS: We included Kaiser Permanente Southern California (KPSC) health plan members who gave birth at ≥20 weeks' gestation in a KPSC-owned hospital during 2008-2017. An SMM case was defined as presence of one or more indicators of an SMM event during a birth hospitalization, identified using maternal electronic health records. Crude SMM rates/10,000 births were calculated by year and maternal race/ethnicity. Modified Poisson regression models were used to assess the association between race/ethnicity and SMM adjusted for other maternal demographics, pregnancy characteristics, and preexisting conditions. RESULTS: We identified 5,915 SMM cases among 335,310 births. Crude SMM rates increased from 94.7 per 10,000 in 2008 to 192.6 in 2015 and 249.5 in 2017. Non-Hispanic Black (adjusted risk ratio [aRR] 1.52; 95% confidence interval [CI] 1.37-1.69), Asian/Pacific Islander (aRR 1.29, 95% CI 1.18-1.41), and Hispanic (aRR 1.18, 95% CI 1.10-1.27) women had greater likelihood of SMM than non-Hispanic White women. After further adjusting for preexisting health conditions, differences in SMM by race/ethnicity remained. CONCLUSIONS: SMM rates increased during 2008-2017 and women of racial and ethnic minority groups, particularly non-Hispanic Black women, were more likely to experience an SMM event than non-Hispanic White women. Multilevel approaches to understanding structural and social factors that may be associated with racial and ethnic disparities in SMM are needed to develop and test effective interventions to reduce SMM.

        Oakley, L. P.

    • Healthcare Associated Infections
      1. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update
        Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, deKay K, Hoffmann KK, Maragakis L, Olmsted RN, Polgreen PM, Trexler PA, VanAmringe MA, Wood AR, Yokoe D, Ellingson KD.
        Infect Control Hosp Epidemiol. 2023 02/21/2023:1-22.
        The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

        Glowicz, J. B.

    • Immunity and Immunization
      1. Relative effectiveness of COVID-19 vaccination and booster dose combinations among 18.9 million vaccinated adults during the early SARS-CoV-2 Omicron period - United States, January 1, 2022-March 31, 2022
        Kompaniyets L, Wiegand RE, Oyalowo AC, Bull-Otterson L, Egwuogu H, Thompson T, Kahihikolo K, Moore L, Jones-Jack N, El Kalach R, Srinivasan A, Messer A, Pilishvili T, Harris AM, Gundlapalli AV, Link-Gelles R, Boehmer TK.
        Clin Infect Dis. 2023 02/21/2023.
        Small sample sizes have limited prior studies' ability to capture severe COVID-19 outcomes, especially among Ad26.COV2.S vaccine recipients. This study of 18.9 million adults aged ≥18 years assessed relative vaccine effectiveness (rVE) in three recipient cohorts: (1) primary Ad26.COV2.S vaccine and Ad26.COV2.S booster (two Ad26.COV2.S), (2) primary Ad26.COV2.S vaccine and mRNA booster (Ad26.COV2.S+mRNA), (3) two doses of primary mRNA vaccine and mRNA booster (three mRNA). The study analyzed two de-identified datasets linked using privacy-preserving record linkage (PPRL): medical and pharmacy insurance claims and COVID-19 vaccination data from retail pharmacies. It assessed the presence of COVID-19 during January 1-March 31, 2022 in: (1) any claim, (2) outpatient claim, (3) emergency department (ED) claim, (4) inpatient claim, and (5) inpatient claim with intensive care unit (ICU) admission. rVE for each outcome comparing three recipient cohorts (reference: two Ad26.COV2.S doses) was estimated from adjusted Cox proportional hazards models. Compared with two Ad26.COV2.S doses, Ad26.COV2.S+mRNA and three mRNA doses were more effective against all COVID-19 outcomes, including 57% (95% CI: 52-62) and 62% (95% CI: 58-65) rVE against an ED visit; 44% (95% CI: 34-52) and 54% (95% CI: 48-59) rVE against hospitalization; and 48% (95% CI: 22-66) and 66% (95% CI: 53-75) rVE against ICU admission, respectively. This study demonstrated that Ad26.COV2.S + mRNA doses were as good as three doses of mRNA, and better than two doses of Ad26.COV2.S. Vaccination continues to be an important preventive measure for reducing the public health impact of COVID-19.

        Kompaniyets, L. | Wiegand, R. E. | Oyalowo, A. C. | Bull-Otterson, L. | Egwuogu, H. | Thompson, T. | Kahihikolo, K. | Moore, L. | Jones-Jack, N. | El Kalach, R. | Srinivasan, A. | Messer, A. | Pilishvili, T. | Harris, A. M. | Gundlapalli, A. V. | Link-Gelles, R. | Boehmer, T. K.

      2. Safety, tolerability, and immunogenicity of inactivated poliovirus vaccine with or without E.coli double mutant heat-labile toxin (dmLT) adjuvant in healthy adults; a phase 1 randomized study
        Erdem R, De Coster I, Withanage K, Mercer LD, Marchant A, Taton M, Cools N, Lion E, Cassels F, Higgins D, Ivinson K, Locke E, Mahmood K, Wright PF, Gast C, White JA, Ackerman ME, Konopka-Anstadt JL, Mainou BA, Van Damme P.
        Vaccine. 2023 02/21/2023.
        BACKGROUND: Inactivated trivalent poliovirus vaccine (IPV) induces humoral immunity, which protects against paralytic poliomyelitis but does not induce sufficient mucosal immunity to block intestinal infection. We assessed the intestinal immunity in healthy adults in Belgium conferred by a co-formulation of IPV with the mucosal adjuvant double mutant Labile Toxin (dmLT) derived from Escherichia coli. METHODS: Healthy fully IPV-vaccinated 18-45-year-olds were randomly allocated to three groups: on Day 1 two groups received one full dose of IPV (n = 30) or IPV + dmLT (n = 30) in a blinded manner, and the third received an open-label dose of bivalent live oral polio vaccine (bOPV types 1 and 3, n = 20). All groups received a challenge dose of bOPV on Day 29. Participants reported solicited and unsolicited adverse events (AE) using study diaries. Mucosal immune responses were measured by fecal neutralization and IgA on Days 29 and 43, with fecal shedding of challenge viruses measured for 28 days. Humoral responses were measured by serum neutralizing antibody (NAb). RESULTS: Solicited and unsolicited AEs were mainly mild-to-moderate and transient in all groups, with no meaningful differences in rates between groups. Fecal shedding of challenge viruses in both IPV groups exceeded that of the bOPV group but was not different between IPV and IPV + dmLT groups. High serum NAb responses were observed in both IPV groups, alongside modest levels of fecal neutralization and IgA. CONCLUSIONS: Addition of dmLT to IPV administered intramuscularly neither affected humoral nor intestinal immunity nor decreased fecal virus shedding following bOPV challenge. The tolerability of the dose of dmLT used in this study may allow higher doses to be investigated for impact on mucosal immunity. Registered on ClinicalTrials.gov - NCT04232943.

        Konopka-Anstadt, J. L. Mainou, B. A.

      3. Spontaneous reports of primary ovarian insufficiency after vaccination: A review of the Vaccine Adverse Event Reporting System (VAERS)
        Patricia Wodi A, Marquez P, Mba-Jonas A, Barash F, Nguon K, Moro PL.
        Vaccine. 2023 02/21/2023.
        BACKGROUND: Since 2012, reports of primary ovarian insufficiency (POI) temporally associated with receipt of human papillomavirus (HPV) vaccine have been published leading to questions about a potential causal association. A Vaccine Safety Datalink study did not find an increased risk for POI after vaccination. We reviewed the Vaccine Adverse Event Reporting System (VAERS) to describe POI reports. METHODS: We searched VAERS, a U.S. passive surveillance system, for domestic POI reports received from 01/01/1990 to 12/31/2017 after any vaccination. The search used both Medical Dictionary for Regulatory Activity Preferred Terms and a text-based search for POI and its symptoms. All reports were reviewed, and the American College of Obstetricians and Gynecologists (ACOG) guidelines for POI diagnosis were applied. Data mining for disproportionate reporting was conducted. RESULTS: Six hundred fifty-two reports met the search criteria and clinical review identified 19 POI reports. Most reports (n = 16) were received between 2013 and 2017. The median age at vaccination was 14.5 years (range 10-25 years) and the median interval between first dose of vaccination and reporting the event to VAERS was 43 months (range 4-132 months; mean 59.6 months). Four reports met ACOG diagnostic criteria; one with an underlying cause (47XXX chromosomal abnormality) reported. Eleven reports documented menstrual irregularity ≥ 3 months; 5 had ≥ 1 laboratory test result used to diagnose POI. Eighteen of 19 reports described receipt of HPV vaccine with or without other vaccines. Other vaccines reported were meningococcal conjugate vaccine, hepatitis A, varicella and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis. Disproportionate reporting was found for three relevant coding terms after HPV vaccination. CONCLUSIONS: POI is rarely reported to VAERS. Most reports contained limited diagnostic information and were submitted after published cases of POI following HPV vaccination. Results of our review do not suggest a safety concern.

        Patricia Wodi, A. Marquez, P. Moro, P. L.

    • Informatics
      1. The future of infodemic surveillance as public health surveillance
        Chiou H, Voegeli C, Wilhelm E, Kolis J, Brookmeyer K, Prybylski D.
        Emerg Infect Dis. 2022 02/21/2023;28(13):S121-s128.
        Public health systems need to be able to detect and respond to infodemics (outbreaks of misinformation, disinformation, information overload, or information voids). Drawing from our experience at the US Centers for Disease Control and Prevention, the COVID-19 State of Vaccine Confidence Insight Reporting System has been created as one of the first public health infodemic surveillance systems. Key functions of infodemic surveillance systems include monitoring the information environment by person, place, and time; identifying infodemic events with digital analytics; conducting offline community-based assessments; and generating timely routine reports. Although specific considerations of several system attributes of infodemic surveillance system must be considered, infodemic surveillance systems share several similarities with traditional public health surveillance systems. Because both information and pathogens are spread more readily in an increasingly hyperconnected world, sustainable and routine systems must be created to ensure that timely interventions can be deployed for both epidemic and infodemic response.

        Chiou, H. | Voegeli, C. | Wilhelm, E. | Kolis, J. | Brookmeyer, K. | Prybylski, D.

      2. Longitudinal analysis of electronic health information to identify possible COVID-19 sequelae
        Click ES, Malec D, Chevinsky J, Tao G, Melgar M, Giovanni J, Gundlapalli A, Datta D, Wong KK.
        Emerg Infect Dis. 2023 02/21/2023;29(2):389-392.
        Ongoing symptoms might follow acute COVID-19. Using electronic health information, we compared pre‒ and post‒COVID-19 diagnostic codes to identify symptoms that had higher encounter incidence in the post‒COVID-19 period as sequelae. This method can be used for hypothesis generation and ongoing monitoring of sequelae of COVID-19 and future emerging diseases.

        Click, E. S. | Malec, D. | Chevinsky, J. | Tao, G. | Melgar, M. | Giovanni, J. | Gundlapalli, A. | Datta, D. | Wong, K. K.

    • Injury and Violence
      1. Return to school after traumatic brain injury: Description of implementation settings
        Haarbauer-Krupa J, Thigpen S, Glang A, Eagan-Johnson B, McAvoy K, Brunken C, Chininis M, Kurowski BG, Suskauer S, Crowley M, Denslow P.
        J Head Trauma Rehabil. 2023 02/21/2023.
        OBJECTIVE: Children who experience traumatic brain injury (TBI) of any severity may need accommodations when they return to school-the setting that manages academic achievement and learning. However, variations exist in current return to school (RTS) programs that address a child's transition to school following TBI. This article describes some of these return to school (RTS) programs and how they vary by setting. DESIGN: This article provides insights from a modified evaluability assessment that examined RTS programs and their readiness for rigorous evaluation. A secondary analysis was conducted to better describe the types and location of programs examined. RESULTS: Differences exist in program structure, access, and how care for children is monitored over time. RTS programs that serve children following TBI are located in healthcare settings, schools, and state agencies and vary in models of care due to their location and organizational structure. CONCLUSIONS: Children who experience TBI benefit from a healthcare assessment and follow-up upon RTS that includes parental involvement. Models of care for this process vary based on program location and organizational structure. Further research and program evaluation are needed to better understand effectiveness and how to optimally monitor and care for children returning to school after a concussion or TBI.

        Haarbauer-Krupa, J. Thigpen, S.

    • Laboratory Sciences
      1. NanoSpotTM collector for aerosol sample collection for direct microscopy and spectroscopy analysis
        Zervaki O, Stump B, Keady P, Dionysiou DD, Kulkarni P.
        Aerosol Sci Technol. 2023 02/21/2023.
        We describe design and characterization of an aerosol NanoSpotTM collector, designed for collection of airborne particles on a microscopy substrate for direct electron and optical microscopy, and laser spectroscopy analysis. The collector implements a water-based, laminar-flow, condensation growth technique, followed by impaction onto an optical/electron microscopy substrate or a transmission electron microscopy grid for direct analysis. The compact design employs three parallel growth tubes allowing a sampling flow rate of 1.2 L min−1. Each growth tube consists of three-temperature regions, for controlling the vapor saturation profile and exit dew point. Following the droplet growth, the three streams merge into one flow and a converging nozzle enhances focusing of grown droplets into a tight beam, prior to their final impaction on the warm surface of the collection substrate. Experiments were conducted for the acquisition of the size-dependent collection efficiency and the aerosol concentration effect on the NanoSpotTM collector. Particles as small as 7 nm were activated and collected on the electron microscopy stub. The collected particle samples were analyzed using electron microscopy and Raman spectroscopy for the acquisition of the particle spatial distribution, the spot sample uniformity, and the analyte concentration. A spot deposit of approximately 0.7-mm diameter is formed for particles over a broad particle diameter range, for effective coupling with microscopic and spectroscopic analysis. Finally, the NanoSpotTM collector’s analytical measurement sensitivity for laser Raman analysis and counting statistics for fiber count measurement using optical microscopy were calculated and were compared with those of the conventional aerosol sampling methods. ©, This work was authored as part of the Contributor's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 USC. 105, no copyright protection is available for such works under US Law.

        Zervaki, O. Kulkarni, P.

      2. Segmented filamentous bacteria impede rotavirus infection via retinoic acid receptor-mediated signaling
        Ngo VL, Shi Z, Jiang B, Gewirtz AT.
        Gut Microbes. 2023 02/21/2023;15(1):2174407.
        Prevention of rotavirus (RV) infection by gut-resident segmented filamentous bacteria (SFB) is an example of the influence of gut microbiota composition on enteric viral infection. Yet, the mechanism by which SFB prevents RV infection is poorly understood. A recent report that SFB colonization of germfree mice generates retinoic acid (RA) thus activating RA receptor (RAR) signaling, which protected against Citrobacter rodentium infection, prompted us to investigate whether this pathway might contribute to SFB's protection against RV infection. Colonization of conventional mice by SFB indeed increased intestinal RA levels and direct administration of RA partially mimicked the protection against RV infection conferred by SFB. Moreover, blockade of RAR signaling eliminated SFB's protection against RV infection. Blockade of RAR signaling did not impact RV infection in the absence of SFB, nor did it alter the protection against RV infection conferred by bacterial flagellin, which in contrast to SFB, is dependent upon IL-22 signaling. SFB/RA-mediated prevention of RV infection was associated with an RA-dependent increase in enterocyte migration, consistent with the notion that enhanced anoikis is the ultimate means by which SFB, IL-22, and RA impede RV infection.

        Shi, Z. Jiang, B.

      3. Results from the second WHO external quality assessment for the molecular detection of respiratory syncytial virus, 2019–2020
        Williams T, Jackson S, Barr I, Bi S, Bhiman J, Ellis J, von Gottberg A, Lindstrom S, Peret T, Rughooputh S, Viegas M, Hirve S, Zambon M, Zhang W, Dia N, Razanazatovo N, Al-Nabet AD, Abubakar A, Tivane A, Barakat A, Naguib A, Aziz A, Vicari A, Moen A, Govindakarnavar A, Hall A, Darmaa B, Nathalie B, Herring B, Caetano BC, Whittaker B, Baumeister E, Nakouné E, Guthrie E, Inbanathan F, Nair H, Campbell H, Kadjo HA, Oumzil H, Heraud JM, Mott JA, Namulondo J, Leite J, Nahapetyan K, Al Ariqi L, Gazo MH, Chadha M, Pisareva M, Venter M, Siqueira MM, Lumandas M, Niang M, Albuaini M, Salman M, Oberste S, Srikantiah P, Tang P, Couto P, Smith P, Coyle PV, Dussart P, Nguyen PN, Okada PA, Wijesinghe PR, Samuel R, Brown R, Pebody R, Fasce R, Jha R, Lindstrom S, Gerber S, Potdar V, Dong X, Deng YM, Who Rsv Surveillance Group.
        Influenza Other Respir Viruses. 2023 02/21/2023;17(1).
        Background: External quality assessments (EQAs) for the molecular detection of human respiratory syncytial virus (RSV) are necessary to ensure the standardisation of reliable results. The Phase II, 2019–2020 World Health Organization (WHO) RSV EQA included 28 laboratories in 26 countries. The EQA panel evaluated performance in the molecular detection and subtyping of RSV-A and RSV-B. This manuscript describes the preparation, distribution, and analysis of the 2019–2020 WHO RSV EQA. Methods: Panel isolates underwent whole genome sequencing and in silico primer matching. The final panel included nine contemporary, one historical virus and two negative controls. The EQA panel was manufactured and distributed by the UK National External Quality Assessment Service (UK NEQAS). National laboratories used WHO reference assays developed by the United States Centers for Disease Control and Prevention, an RSV subtyping assay developed by the Victorian Infectious Diseases Reference Laboratory (Australia), or other in-house or commercial assays already in use at their laboratories. Results: An in silico analysis of isolates showed a good match to assay primer/probes. The panel was distributed to 28 laboratories. Isolates were correctly identified in 98% of samples for detection and 99.6% for subtyping. Conclusions: The WHO RSV EQA 2019–2020 showed that laboratories performed at high standards. Updating the composition of RSV molecular EQAs with contemporary strains to ensure representation of circulating strains, and ensuring primer matching with EQA panel viruses, is advantageous in assessing diagnostic competencies of laboratories. Ongoing EQAs are recommended because of continued evolution of mismatches between current circulating strains and existing primer sets. © 2023 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.

        Lindstrom, S.

      4. Spike gene target amplification in a diagnostic assay as a marker for public health monitoring of emerging SARS-CoV-2 variants - United States, November 2021-January 2023
        Scobie HM, Ali AR, Shirk P, Smith ZR, Paul P, Paden CR, Hassell N, Zheng XY, Lambrou AS, Kondor R, MacCannell D, Thornburg NJ, Miller J, Wentworth D, Silk BJ.
        MMWR Morb Mortal Wkly Rep. 2023 02/21/2023;72(5):125-127.
        Monitoring emerging SARS-CoV-2 lineages and their epidemiologic characteristics helps to inform public health decisions regarding vaccine policy, the use of therapeutics, and health care capacity. When the SARS-CoV-2 Alpha variant emerged in late 2020, a spike gene (S-gene) deletion (Δ69-70) in the N-terminal region, which might compensate for immune escape mutations that impair infectivity (1), resulted in reduced or failed S-gene target amplification in certain multitarget reverse transcription-polymerase chain reaction (RT-PCR) assays, a pattern referred to as S-gene target failure (SGTF) (2). The predominant U.S. SARS-CoV-2 lineages have generally alternated between SGTF and S-gene target presence (SGTP), which alongside genomic sequencing, has facilitated early monitoring of emerging variants. During a period when Omicron BA.5-related sublineages (which exhibit SGTF) predominated, an XBB.1.5 sublineage with SGTP has rapidly expanded in the northeastern United States and other regions.

        Scobie, H. M. Ali, A. R. Shirk, P. Smith, Z. R. Paul, P. Paden, C. R. Hassell, N. Zheng, X. Y. Lambrou, A. S. Kondor, R. MacCannell, D. Thornburg, N. J. Miller, J. Wentworth, D. Silk, B. J.

    • Maternal and Child Health
      1. A qualitative evaluation and conceptual framework on the use of the Birth weight and Age-at-death Boxes for Intervention and Evaluation System (BABIES) matrix for perinatal health in Uganda
        Dynes MM, Daniel GA, Mac V, Picho B, Asiimwe A, Nalutaaya A, Opio G, Kamara V, Kaharuza F, Serbanescu F.
        BMC Pregnancy Childbirth. 2023 02/21/2023;23(1):86.
        BACKGROUND: Perinatal mortality (newborn deaths in the first week of life and stillbirths) continues to be a significant global health threat, particularly in resource-constrained settings. Low-tech, innovative solutions that close the quality-of-care gap may contribute to progress toward the Sustainable Development Goals for health by 2030. From 2012 to 2018, the Saving Mothers, Giving Life Initiative (SMGL) implemented the Birth weight and Age-at-Death Boxes for Intervention and Evaluation System (BABIES) matrix in Western Uganda. The BABIES matrix provides a simple, standardized way to track perinatal health outcomes to inform evidence-based quality improvement strategies. METHODS: In November 2017, a facility-based qualitative evaluation was conducted using in-depth interviews with 29 health workers in 16 health facilities implementing BABIES in Uganda. Data were analyzed using directed content analysis across five domains: 1) perceived ease of use, 2) how the matrix was used, 3) changes in behavior or standard operating procedures after introduction, 4) perceived value of the matrix, and 5) program sustainability. RESULTS: Values in the matrix were easy to calculate, but training was required to ensure correct data placement and interpretation. Displaying the matrix on a highly visible board in the maternity ward fostered a sense of accountability for health outcomes. BABIES matrix reports were compiled, reviewed, and responded to monthly by interprofessional teams, prompting collaboration across units to fill data gaps and support perinatal death reviews. Respondents reported improved staff communication and performance appraisal, community engagement, and ability to track and link clinical outcomes with actions. Midwives felt empowered to participate in the problem-solving process. Respondents were motivated to continue using BABIES, although sustainability concerns were raised due to funding and staff shortages. CONCLUSIONS: District-level health systems can use data compiled from the BABIES matrix to inform policy and guide implementation of community-centered health practices to improve perinatal heath. Future work may consider using the Conceptual Framework on Use of the BABIES Matrix for Perinatal Health as a model to operationalize concepts and test the impact of the tool over time.

        Dynes, M. M. Serbanescu, F.

      2. IMPORTANCE: Infants younger than 1 year have the highest burden of pertussis morbidity and mortality. In 2011, the US introduced tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination during pregnancy to protect infants before vaccinations begin. OBJECTIVE: To assess the association of maternal Tdap vaccination during pregnancy with the incidence of pertussis among infants in the US. DESIGN, SETTING, AND PARTICIPANTS: In this ecologic study, a time-trend analysis was performed of infant pertussis cases reported through the National Notifiable Diseases Surveillance System between January 1, 2000, and December 31, 2019, in the US. Statistical analysis was performed from April 1, 2020, to October 31, 2022. EXPOSURES: Maternal Tdap vaccination during pregnancy. MAIN OUTCOMES AND MEASURES: Pertussis incidence rates were calculated and compared between 2 periods-the pre-maternal Tdap vaccination period (2000-2010) and the post-maternal Tdap vaccination period (2012-2019)-for 2 age groups: infants younger than 2 months (target group of maternal vaccination) and infants aged 6 months to less than 12 months (comparison group). Incidence rate differences between the 2 age groups were modeled using weighted segmented linear regression. The slope difference between the 2 periods was estimated to assess the association of maternal Tdap vaccination with pertussis incidence among infants. RESULTS: A total of 57 460 pertussis cases were reported in infants younger than 1 year between 2000 and 2019; 19 322 cases (33.6%) were in infants younger than 2 months. During the pre-maternal Tdap vaccination period, annual pertussis incidence did not change among infants younger than 2 months (slope, 3.29 per 100 000 infants per year; P = .28) but increased slightly among infants aged 6 months to less than 12 months (slope, 2.10 per 100 000 infants per year; P = .01). There was no change in the difference in incidence between the 2 age groups (slope, 0.08 per 100 000 infants per year; P = .97) during the pre-maternal Tdap vaccination period overall. However, in the post-maternal Tdap vaccination period, incidence decreased among infants younger than 2 months (slope, -14.53 per 100 000 infants per year; P = .001) while remaining unchanged among infants aged 6 months to less than 12 months (slope, 1.42 per 100 000 infants per year; P = .29). The incidence rate difference between the 2 age groups significantly decreased during the post-maternal Tdap vaccination period (slope, -14.43 per 100 000 infants per year; P < .001). Pertussis incidence rate differences were significantly different between the pre-maternal and post-maternal Tdap vaccination periods (slope difference, -14.51 per 100 000 infants per year; P = .01). CONCLUSIONS AND RELEVANCE: In this study, following maternal Tdap vaccine introduction, a sustained decrease in pertussis incidence was observed among infants younger than 2 months, narrowing the incidence gap with infants aged 6 months to less than 12 months. These findings suggest that maternal Tdap vaccination is associated with a reduction in pertussis burden in the target age group (<2 months) and that further increases in coverage may be associated with additional reductions in infant disease.

        Skoff, T. H. | Deng, L. | Bozio, C. H. | Hariri, S.

      3. Association between influenza vaccination during pregnancy and infant influenza vaccination
        Zhou F, Lindley MC, Lee JT, Jatlaoui TC.
        Obstet Gynecol. 2023 02/21/2023.
        OBJECTIVE: To examine the association between influenza vaccination during pregnancy and infant influenza vaccination. METHODS: We conducted a retrospective analysis of individuals aged 15-49 years who were continually privately insured from August 2017 to May 2019 and had singleton live births between September 2017 and February 2018 and their infants. Influenza vaccination coverage was assessed for pregnant people during the 2017-2018 influenza season and for their infants during the 2018-2019 season using the 2017-2019 MarketScan data. Multivariate log-binomial regressions were conducted to examine the association between influenza vaccination during pregnancy and infant influenza vaccination. RESULTS: Of the 34,919 pregnant people in this analysis, 14,168 (40.6%) received influenza vaccination during pregnancy. Of the infants born to people vaccinated during pregnancy, 90.0% received at least one dose of influenza vaccine during the 2018-2019 season and 75.5% received at least two doses. Of the infants born to those not vaccinated during pregnancy, 66.3% received at least one dose of influenza vaccine and 51.8% received at least two doses. At-least-one-dose coverage was 35.7% higher (adjusted risk ratio [aRR] 1.34, 95% CI 1.33-1.36) and at-least-two-dose coverage was 45.8% higher (aRR 1.43, 95% CI 1.41-1.46) for infants born to people who received influenza vaccination during pregnancy compared with infants born to people who did not. CONCLUSION: Our results show a positive and statistically significant relationship between influenza vaccination during pregnancy and infant influenza vaccination status in their first season eligible for vaccination. Interventions to increase influenza vaccination coverage among pregnant people may also increase infant influenza vaccination coverage, offering greater protection against serious complications of influenza in both vulnerable populations.

        Zhou, F. Lindley, M. C. Lee, J. T. Jatlaoui, T. C.

    • Occupational Safety and Health
      1. Transmission of SARS-CoV-2 in the workplace: Key findings from a rapid review of the literature
        Cox J, Christensen B, Burton N, Dunn KH, Finnegan M, Ruess A, Estill C.
        Aerosol Sci Technol. 2023 02/21/2023.
        At the beginning of the COVID-19 pandemic, the primary route of transmission of the SARS-CoV-2 virus was not well understood. Research gathered from other respiratory infectious diseases, including other coronaviruses, was the basis for the initial perceptions for transmission of SARS-CoV-2. To better understand transmission of SARS-CoV-2, a rapid literature review was conducted from literature generated 19 March 2020, through 23 September 2021. 18,616 unique results were identified from literature databases and screened. Of these, 279 key articles were reviewed and abstracted covering critical topics such as environmental/workplace monitoring, sampling and analytical method evaluation, and the ability of the virus to remain intact and infectious during sampling. This paper describes the results of the rapid literature review, which evaluated pathways that contribute to transmission as well as the strengths and limitations of current sampling approaches. This review also evaluates how different factors, including environmental conditions and surface characteristics, could impact the transmission potential of SARS-CoV-2. A continual rapid review in the midst of a pandemic proved particularly useful for quickly understanding the transmission parameters of the virus and enabled us to comprehensively assess literature, respond to workplace questions, and evaluate our understanding as the science evolved. Air and surface sampling with the accompanying analytical methods were not generally effective in recovering SARS-CoV-2 viable virus or RNA in many likely contaminated environments. In light of these findings, the development of validated sampling and analysis methods is critical for determining worker exposure to SARS-CoV-2 and to assess the impact of mitigation efforts. © This work was authored as part of the Contributor’s official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.

        Cox, J. Christensen, B. Burton, N. Dunn, K. H. Estill, C.

      2. INTRODUCTION: Workers in the healthcare industry are at increased risk for workplace violence. The goal of this analysis is to determine the rate of injuries healthcare workers incurred as a result of intentional violence by patients in the workplace. METHODS: Injuries linked to workplace violence that were treated in US emergency departments from 2015 to 2017 were identified using data from the National Electronic Injury Surveillance System-Occupational Supplement (NEISS-Work). All estimates and 95% confidence intervals were calculated using SAS® 9.4 Proc Survey to incorporate the stratified sample design of NEISS-Work. RESULTS: Approximately 1.14 million injuries to workers in the healthcare industry were treated in US hospital emergency departments between 2015 and 2017. Intentional injuries by another person accounted for 15% of these healthcare-related injuries. The results also showed that male healthcare workers' rate of injuries was 2.3 times higher than their female counterparts despite composing a smaller proportion of the workforce. Injury rates were highest among the less-than-25 age group, and decreased as healthcare workers' age increased. CONCLUSIONS: Workplace violence is a serious problem in today's healthcare settings that affects both employees and patient care. Although violence in the healthcare industry has been researched for decades, there has been an increase in violent incidents in this industrial sector. The disparity in injury rates by sex and age are areas of concern. Further research in these areas is necessary to understand the root causes of these incidents and inform violence prevention strategies.

        Carey, I. | Hendricks, K.

      3. Occupational monkeypox virus transmission to healthcare worker, California, USA, 2022
        Alarcón J, Kim M, Balanji N, Davis A, Mata F, Karan A, Finn LE, Guerrero A, Walters M, Terashita D, Balter SE.
        Emerg Infect Dis. 2023 02/21/2023;29(2):435-437.
        Risk for transmission of monkeypox virus (MPXV) (clade IIb) to healthcare workers (HCWs) is low. Although many cases have been reported among HCW, only a few have been occupationally acquired. We report a case of non-needle stick MPXV transmission to an HCW in the United States.

        Alarcón, J.

      4. The anterior and posterior iliac spine markers frequently used to define the pelvis, are commonly occluded during three-dimensional (3D) motion capture. The occlusion of these markers leads to the use of various tracking marker configurations on the pelvis, which affect kinematic results. The purpose of this investigation was to examine the agreement of CODA pelvis kinematic results when two different tracking marker configurations were used during roofing tasks. 3D motion data were collected on seven male subjects while mimicking two roofing tasks. Hip joint angles (HJAs) were computed using the CODA pelvis with two different tracking marker configurations, the trochanter tracking method (TTM), and virtual pelvis tracking method (VPTM). Agreement between tracking marker configurations was assessed using cross-correlations, bivariate correlations, mean absolute differences (MADs), and Bland-Altman (BA) plots. The correlations displayed no time lag and strong agreement (all r>0.83) between the HJA from the VPTM and TTM, suggesting the timing occurrence of variables are comparable between the two tracking marker configurations. The MAD between the VPTM and TTM displayed magnitude differences, but most of the differences were within a clinically acceptable range. Caution should still be used when comparing kinematic results between various tracking marker configurations, as differences exist. © 2023 World Scientific Publishing Company.

        Moore, K. D. Hawke, A. L. Carey, R. E. Wu, J. Z. Breloff, S. P.

      5. Mining tenure and job duties differ among contemporary and historic underground coal miners with progressive massive fibrosis
        Zell-Baran L, Go LH, Sarver E, Almberg KS, Iwaniuk C, Green FH, Abraham JL, Cool C, Franko A, Hubbs AF, Murray J, Orandle MS, Sanyal S, Vorajee N, Cohen RA, Rose CS.
        J Occup Environ Med. 2022 02/21/2023.
        OBJECTIVE: To characterize differences in mining jobs and tenure between contemporary (born 1930+, working primarily with modern mining technologies) and historic coal miners with progressive massive fibrosis (PMF). METHODS: We classified jobs as designated occupations (DOs) and non-DOs based on regulatory sampling requirements. Demographic, occupational characteristics, and histopathological PMF type were compared between groups. RESULTS: Contemporary miners (n = 33) had significantly shorter mean total (30.4 years vs. 37.1 years, p = 0.0006) and underground (28.8 years vs. 35.8 years, p = 0.001) mining tenure compared to historic miners (n = 289). Silica-type PMF was significantly more common among miners in non-DOs (30.1% vs. 15.8%, p = 0.03) and contemporary miners (58.1% vs. 15.2%, p < 0.0001). CONCLUSIONS: Primary jobs changed over time with the introduction of modern mining technologies and likely changed exposures for workers. Elevated crystalline silica exposures are likely in non-DOs and require attention.

        Hubbs, A. F. Orandle, M. S.

    • Parasitic Diseases
      1. Low treatment rates of parasitic diseases with standard-of-care prescription drugs in the United States, 2013-2019
        Joo H, Maskery BA, Alpern JD, Chancey RJ, Weinberg M, Stauffer WM.
        Am J Trop Med Hyg. 2022 02/21/2023;107(4):780-784.
        To assess appropriate drug treatment of parasitic diseases in the United States, we examined the treatment rates of 11 selected parasitic infections with standard-of-care prescription drugs and compared them to the treatment rates of two more common bacterial infections (Clostridioides difficile and streptococcal pharyngitis). We used the 2013 to 2019 IBM® MarketScan® Commercial Claims and Encounters and MarketScan® Multi-State Medicaid databases, which included up to 7 years of data for approximately 88 million and 17 million individuals, respectively, to estimate treatment rates of each infection. The number of patients diagnosed with each parasitic infection varied from 57 to 5,266, and from 12 to 2,018, respectively, across the two databases. Treatment rates of 10 of 11 selected parasitic infections (range, 0-56%) were significantly less than those for streptococcal pharyngitis and Clostridioides difficile (range, 65-85%); giardiasis treatment (64%) was comparable to Clostridioides difficile (65%) in patients using Medicaid. Treatment rates for patients with opisthorchiasis, clonorchiasis, and taeniasis were less than 10%. Although we could not verify that patients had active infections because of limitations inherent to claims data, including coding errors and the inability to review patients' charts, these data suggest a need for improved treatment of parasitic infections. Further research is needed to verify the results and identify potential clinical and public health consequences.

        Joo, H. Maskery, B. A. Alpern, J. D. Weinberg, M. Stauffer, W. M.

      2. Plasmodium falciparum infection prevalence among children aged 6-59 months from independent DHS and HIV surveys: Nigeria, 2018
        Oviedo A, Abubakar A, Uhomoibhi P, Maire M, Inyang U, Audu B, Iriemenam NC, Ogunniyi A, Ssekitooleko J, Kalambo JA, Greby SM, Mba N, Swaminathan M, Ihekweazu C, Okoye MI, Rogier E, Steinhardt LC.
        Sci Rep. 2023 02/21/2023;13(1):1998.
        Prevalence estimates are critical for malaria programming efforts but generating these from non-malaria surveys is not standard practice. Malaria prevalence estimates for 6-59-month-old Nigerian children were compared between two national household surveys performed simultaneously in 2018: a Demographic and Health Survey (DHS) and the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). DHS tested via microscopy (n = 8298) and HRP2-based rapid diagnostic test (RDT, n = 11,351), and NAIIS collected dried blood spots (DBS) which were later tested for histidine-rich protein 2 (HRP2) antigen (n = 8029). National Plasmodium falciparum prevalence was 22.6% (95% CI 21.2- 24.1%) via microscopy and 36.2% (34.6- 37.8%) via RDT according to DHS, and HRP2 antigenemia was 38.3% (36.7-39.9%) by NAIIS DBS. Between the two surveys, significant rank-order correlation occurred for state-level malaria prevalence for RDT (Rho = 0.80, p < 0.001) and microscopy (Rho = 0.75, p < 0.001) versus HRP2. RDT versus HRP2 positivity showed 24 states (64.9%) with overlapping 95% confidence intervals from the two independent surveys. P. falciparum prevalence estimates among 6-59-month-olds in Nigeria were highly concordant from two simultaneous, independently conducted household surveys, regardless of malaria test utilized. This provides evidence for the value of post-hoc laboratory HRP2 detection to leverage non-malaria surveys with similar sampling designs to obtain accurate P. falciparum estimates.

        Oviedo, A. Iriemenam, N. C. Swaminathan, M. Okoye, M. I. Steinhardt, L. C.

    • Reproductive Health
      1. Strategies to increase uptake of voluntary medical male circumcision among men aged 25-39 years in Nyanza Region, Kenya: Results from a cluster randomized controlled trial (the TASCO study)
        Grund JM, Onchiri F, Mboya E, Ussery F, Musingila P, Ohaga S, Odoyo-June E, Bock N, Ayieko B, Agot K.
        PLoS One. 2023 02/21/2023;18(2):e0276593.
        INTRODUCTION: Voluntary medical male circumcision (VMMC) for HIV prevention began in Nyanza Region, Kenya in 2008. By 2014, approximately 800,000 VMMCs had been conducted, and 84.9% were among males aged 15-24 years. We evaluated the impact of interpersonal communication (IPC) and dedicated service outlets (DSO) on VMMC uptake among men aged 25-39 years in Nyanza Region. MATERIALS AND METHODS: We conducted a cluster randomized controlled trial in 45 administrative Locations (clusters) in Nyanza Region between May 2014 and June 2016 among uncircumcised men aged 25-34 years. In arm one, an IPC toolkit was used to address barriers to VMMC. In the second arm, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO arms, and arm four was standard of care (SOC). Randomization was done at Location level (11-12 per arm). The primary outcome was the proportion of enrolled men who received VMMC within three months. Generalized estimating equations were used to evaluate the effect of interventions on the outcome. RESULTS: At baseline, 9,238 households with men aged 25-39 years were enumerated, 9,679 men were assessed, and 2,792 (28.8%) were eligible. For enrollment, 577 enrolled in the IPC arm, 825 in DSO, 723 in combined IPC + DSO, and 667 in SOC. VMMC uptake among men in the SOC arm was 3.2%. In IPC, DSO, and combined IPC + DSO arms, uptake was 3.3%, 4.5%, and 4.4%, respectively. The adjusted odds ratio (aOR) of VMMC uptake in the study arms compared to SOC were IPC aOR = 1.03; 95% CI: 0.50-2.13, DSO aOR = 1.31; 95% CI: 0.67-2.57, and IPC + DSO combined aOR = 1.31, 95% CI: 0.65-2.67. DISCUSSION: Using these interventions among men aged 25-39 years did not significantly impact VMMC uptake. These findings suggest that alternative demand creation strategies for VMMC services are needed to reach men aged 25-39 years. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02497989.

        Grund, J. M. Ussery, F. Musingila, P. Odoyo-June, E. Bock, N.

    • Social and Behavioral Sciences
      1. Rapid onset of functional tic-like behaviors among adolescent girls-Minnesota, September-November 2021
        Firestone MJ, Holzbauer S, Conelea C, Danila R, Smith K, Bitsko RH, Klammer SM, Gingerich S, Lynfield R.
        Front Neurol. 2022 02/21/2023;13:1063261.
        BACKGROUND: On October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations. METHODS: Affected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens. RESULTS: Eight students had tic-like behaviors lasting >24 h after initial report with onset during September 26-October 30, 2021. All eight students were females aged 15-17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset. CONCLUSION: The onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health.

        Firestone, M. J. Holzbauer, S. Bitsko, R. H.

      2. We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K–12) students (aged 5–19 years) in four US school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area under the curve (AUC) statistics representing prediction of any externalizing disorder (0.73 for both measures) were higher than the AUCs predicting any internalizing disorder (0.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures. © 2023 Wiley Periodicals LLC.

        Danielson, M. L. | Lipton, C. | Charania, S. | Young, H. E.

    • Substance Use and Abuse
      1. Substance use policy and practice in the COVID-19 pandemic: Learning from early pandemic responses through internationally comparative field data
        Aronowitz SV, Carroll JJ, Hansen H, Jauffret-Roustide M, Parker CM, Suhail-Sindhu S, Albizu-Garcia C, Alegria M, Arrendondo J, Baldacchino A, Bluthenthal R, Bourgois P, Burraway J, Chen JS, Ekhtiari H, Elkhoy H, Farhoudian A, Friedman J, Jordan A, Kato L, Knight K, Martinez C, McNeil R, Murray H, Namirembe S, Radfar R, Roe L, Sarang A, Scherz C, Tay Wee Teck J, Textor L, Thi Hai Oanh K.
        Glob Public Health. 2022 02/21/2023;17(12):3654-3669.
        The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.

        Kato, L.

      2. Systematic review: Polysubstance prevalence estimates reported during pregnancy, US, 2009-2020
        Tran EL, England LJ, Park Y, Denny CH, Kim SY.
        Matern Child Health J. 2023 02/21/2023.
        INTRODUCTION: The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US. METHODS: This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility. RESULTS: A total of 119 studies were included: 7 case-control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1-99%; marijuana 3-95%; tobacco/nicotine 2-95%). DISCUSSION: Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.

        Tran, E. L. England, L. J. Park, Y. Denny, C. H. Kim, S. Y.

      3. Support for policies to prohibit the sale of menthol cigarettes and all tobacco products among adults, 2021
        Al-Shawaf M, Grooms KN, Mahoney M, Buchanan Lunsford N, Lawrence Kittner D.
        Prev Chronic Dis. 2023 02/21/2023;20:E05.
        This study assessed support for commercial tobacco retail policies among adults. Data came from SpringStyles 2021, a web panel survey of adults in the US aged 18 years or older (N = 6,455). Overall, 62.3% of adults supported a policy prohibiting the sale of menthol cigarettes, and 57.3% supported a policy prohibiting the sale of all tobacco products. A majority of adults supported tobacco retail policies aimed at preventing initiation, promoting quitting, and reducing tobacco-related disparities. These findings can help inform federal, state, and local efforts to prohibit the sale of tobacco products, including menthol cigarettes.

        Al-Shawaf, M. Grooms, K. N. Mahoney, M. Buchanan Lunsford, N. Lawrence Kittner, D.

    • Telehealth and Telemedicine
      1. Mobile Health and Wellness Project: A binational collaboration of frontline health services to the Latino population in the United States in times of COVID-19
        Rosales CB, Dávila Chávez H, Flynn MA, Lara J, Lira Chávez IA, Olivares Marín L, Romero Rangel A, Hirata Okamoto R, Rangel Gómez MG.
        Front Public Health. 2022 02/21/2023;10:1022772.
        Hardly reached communities in the United States greatly benefit from collective efforts and partnerships from Community Based Organizations, Health Institutions and Government Agencies, yet the effort to engage in this collaborative effort is minimal and funding to support these projects is lacking. The COVID-19 Pandemic exacerbated on a national scale what many vulnerable communities experience regularly; difficult access to basic medical care, information and support. In an effort to directly engage with community organizations and curb the infection rate of the COVID-19 virus within vulnerable communities, the US Centers for Disease Control and Prevention (CDC) launched its first targeted effort to partner directly with community based organizations. This article will highlight the first pilot year of activities and key results of COVID-19 education and vaccination efforts by the Mobile Health and Wellness project. This is a fleet of 11 Mobile Health Vehicles managed by the Mexico Section US-Mexico Border Health Commission in partnership with Alianza Americas, Latino Commission on AIDS, and the CDC, targeting Latino, Immigrant and rural communities across the US.

        Flynn, M. A.

    • Zoonotic and Vectorborne Diseases
      1. Spatiotemporal distribution of vector mosquito species and areas at risk for arbovirus transmission in Maricopa County, Arizona
        Wilke AB, Damian D, Litvinova M, Byrne T, Zardini A, Poletti P, Merler S, Mutebi JP, Townsend J, Ajelli M.
        Acta Trop. 2023 02/21/2023;240:106833.
        Mosquito-borne diseases are a major global public health concern and mosquito surveillance systems are essential for the implementation of effective mosquito control strategies. The objective of our study is to determine the spatiotemporal distribution of vector mosquito species in Maricopa County, AZ from 2011 to 2021, and to identify the hotspot areas for West Nile virus (WNV) and St. Louis Encephalitis virus (SLEV) transmission in 2021. The Maricopa County Mosquito Control surveillance system utilizes BG-Sentinel and EVS-CDC traps throughout the entire urban and suburban areas of the county. We estimated specific mosquito species relative abundance per unit area using the Kernel density estimator in ArcGIS 10.2. We calculated the distance between all traps in the surveillance system and created a 4 km buffer radius around each trap to calculate the extent to which each trap deviated from the mean number of Cx. quinquefasciatus and Cx. tarsalis collected in 2021. Our results show that vector mosquito species are widely distributed and abundant in the urban areas of Maricopa County. A total of 691,170 Culex quinquefasciatus, 542,733 Culex tarsalis, and 292,305 Aedes aegypti were collected from 2011 to 2022. The relative abundance of Ae. aegypti was highly seasonal peaking in the third and fourth quarters of the year. Culex quinquefasciatus, on the other hand, was abundant throughout the year with several regions consistently yielding high numbers of mosquitoes. Culex tarsalis was abundant but it only reached high numbers in well-defined areas near irrigated landscapes. We also detected high levels of heterogeneity in the risk of WNV and SLEV transmission to humans disregarding traps geographical proximity. The well-defined species-specific spatiotemporal and geographical patterns found in this study can be used to inform vector control operations.

        Mutebi, J. P.

      2. Yersinia pestis Δ ail mutants are not susceptible to human complement bactericidal activity in the flea
        Kolodziejek AM, Bearden SW, Maes S, Montenieri JM, Gage KL, Hovde CJ, Minnich SA.
        Appl Environ Microbiol. 2023 02/21/2023:e0124422.
        Ail confers serum resistance in humans and is a critical virulence factor of Y. pestis, the causative agent of plague. Here, the contribution of Ail for Y. pestis survival in the flea vector was examined. Rat or human but not mouse sera were bactericidal against a Y. pestis Δail mutant at 28°C in vitro. Complement components deposited rapidly on the Y. pestis surface as measured by immunofluorescent microscopy. Ail reduced the amount of active C3b on the Y. pestis surface. Human sera retained bactericidal activity against a Y. pestis Δail mutant in the presence of mouse sera. However, in the flea vector, the serum protective properties of Ail were not required. Flea colonization studies using murine sera and Y. pestis KIM6(+) wild type, a Δail mutant, and the Δail/ail(+) control showed no differences in bacterial prevalence or numbers during the early stage of flea colonization. Similarly, flea studies with human blood showed Ail was not required for serum resistance. Finally, a variant of Ail (Ail(F100V E108_S109insS)) from a human serum-sensitive Y. pestis subsp. microtus bv. Caucasica 1146 conferred resistance to human complement when expressed in the Y. pestis KIM6(+) Δail mutant. This indicated that Ail activity was somehow blocked, most likely by lipooligosaccharide, in this serum sensitive strain. IMPORTANCE This work contributes to our understanding of how highly virulent Y. pestis evolved from its innocuous enteric predecessor. Among identified virulence factors is the attachment invasion locus protein, Ail, that is required to protect Y. pestis from serum complement in all mammals tested except mice. Murine sera is not bactericidal. In this study, we asked, is bactericidal sera from humans active in Y. pestis colonized fleas? We found it was not. The importance of this observation is that it identifies a protective niche for the growth of serum sensitive and nonsensitive Y. pestis strains.

        Bearden, S. W. Maes, S. Montenieri, J. M. Gage, K. L.

      3. Melioidosis in cynomolgus macaques ( macaca fascicularis ) imported to the United States from Cambodia
        Taetzsch SJ, Swaney EM, Gee JE, Hidalgo PM, Broussard KR, Martines RB, Blaney DD, Galland GG, Gulvik CA, Marston CK, Liu L, Elrod MG, DeLeon-Carnes M, Tyler RD, Bower WA, Bhatnager J, Brown CM, Pieracci EG, Weiner ZP.
        Comp Med. 2022 02/21/2023;72(6):394-402.
        Melioidosis, a potentially fatal infectious disease of humans and animals, including nonhuman primates (NHPs), is caused by the high-consequence pathogen Burkholderia pseudomallei. This environmental bacterium is found in the soil and water of tropical regions, such as Southeast Asia, where melioidosis is endemic. The global movement of humans and animals can introduce B. pseudomallei into nonendemic regions of the United States, where environmental conditions could allow establishment of the organism. Approximately 60% of NHPs imported into the United States originate in countries considered endemic for melioidosis. To prevent the introduction of infectious agents to the United States, the Centers for Disease Control and Prevention (CDC) requires newly imported NHPs to be quarantined for at least 31 d, during which time their health is closely monitored. Most diseases of public health concern that are transmissible from imported NHPs have relatively short incubation periods that fall within the 31-d quarantine period. However, animals infected with B. pseudomallei may appear healthy for months to years before showing signs of illness, during which time they can shed the organism into the environment. Melioidosis presents diagnostic challenges because it causes nonspecific clinical signs, serologic screening can produce unreliable results, and culture isolates are often misidentified on rapid commercial testing systems. Here, we present a case of melioidosis in a cynomolgus macaque (Macaca fascicularis) that developed a subcutaneous abscess after importation from Cambodia to the United States. The bacterial isolate from the abscess was initially misidentified on a commercial test. This case emphasizes the possibility of melioidosis in NHPs imported from endemic countries and its associated diagnostic challenges. If melioidosis is suspected, diagnostic samples and culture isolates should be submitted to a laboratory in the CDC Laboratory Response Network for conclusive identification and characterization of the pathogen.

        Taetzsch, S. J. Gee, J. E. Martines, R. B. Blaney, D. D. Galland, G. G. Gulvik, C. A. Marston, C. K. Liu, L. Elrod, M. G. DeLeon-Carnes, M. Bower, W. A. Bhatnager, J. Brown, C. M. Pieracci, E. G. Weiner, Z. P.

      4. Nipah virus exposure in domestic and peridomestic animals living in human outbreak sites, Bangladesh, 2013-2015
        Islam A, Cannon DL, Rahman MZ, Khan SU, Epstein JH, Daszak P, Luby SP, Montgomery JM, Klena JD, Gurley ES.
        Emerg Infect Dis. 2023 02/21/2023;29(2):393-396.
        Spillovers of Nipah virus (NiV) from Pteropus bats to humans occurs frequently in Bangladesh, but the risk for spillover into other animals is poorly understood. We detected NiV antibodies in cattle, dogs, and cats from 6 sites where spillover human NiV infection cases occurred during 2013-2015.

        Cannon, D. L. Montgomery, J. M. Klena, J. D.

      5. Orthopoxvirus infections in rodents, Nigeria, 2018-2019
        Meseko C, Adedeji A, Shittu I, Obishakin E, Nanven M, Suleiman L, Okomah D, Tyakaray V, Kolade D, Yinka-Ogunleye A, Muhammad S, Morgan CN, Matheny A, Nakazawa Y, McCollum A, Doty JB.
        Emerg Infect Dis. 2023 02/21/2023;29(2):433-434.
        To investigate animal reservoirs of monkeypox virus in Nigeria, we sampled 240 rodents during 2018-2019. Molecular (real-time PCR) and serologic (IgM) evidence indicated orthopoxvirus infections, but presence of monkeypox virus was not confirmed. These results can be used to develop public health interventions to reduce human infection with orthopoxviruses.

        Muhammad, S. Morgan, C. N. Matheny, A. Nakazawa, Y. McCollum, A. Doty, J. B.

      6. Relapsing fever caused by borrelia lonestari after tick bite in Alabama, USA
        Vazquez Guillamet LJ, Marx GE, Benjamin W, Pappas P, Lieberman NA, Bachiashvili K, Leal S, Lieberman JA.
        Emerg Infect Dis. 2023 02/21/2023;29(2):441-444.
        We report an immunocompromised patient in Alabama, USA, 75 years of age, with relapsing fevers and pancytopenia who had spirochetemia after a tick bite. We identified Borrelia lonestari by using PCR, sequencing, and phylogenetic analysis. Increasing clinical availability of molecular diagnostics might identify B. lonestari as an emerging tickborne pathogen.

        Marx, G. E.


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