Issue 20 May 17, 2016
CDC Science Clips: Volume 8, Issue 20, May 17, 2016
Each Tuesday, to enhance awareness of emerging scientific knowledge, selected science clips will be posted here for the public health community. The focus is applied public health research and prevention science that has the capacity to improve health now.
Subject matter experts decide what topic to feature, and articles are selected from the last 3 to 6 months of published literature. Key topic coincides monthly with other CDC products (e.g. Vital Signs).
Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008External
George MG, Tong X, Kuklina EV, Labarthe DR.
Ann Neurol. 2011 Nov;70(5):713-21.
Recommendations for the establishment of stroke systems of care: Recommendations from the American Stroke Association’s Task Force on the Development of Stroke SystemsExternal
Schwamm LH, Pancioli A, Acker JE, Goldstein LB, Zorowitz RD, Shephard TJ, Moyer P, Gorman M, Johnston SC, Duncan PW, Gorelick P, Frank J, Stranne SK, Smith R, Federspiel W, Horton KB, Magnis E, Adams RJ.
Circulation. 2005 Mar 1;111(8):1078-91.
Epidemiology and prevention of stroke: A worldwide perspectiveExternal
Kuklina EV, Tong X, George MG, Bansil P.
Expert Rev Neurother. 2012 Feb;12(2):199-208.
Stroke and cognitive declineExternal
Gorelick PB, Nyenhuis D.
JAMA. 2015 Jul 7;314(1):29-30.
Blood pressure and the prevention of cognitive impairmentExternal
JAMA Neurol. 2014 Oct;71(10):1211-3.
Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010External
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O’Donnell M, Venketasubramanian N, Barker-Collo S, Lawes CM, Wang W, Shinohara Y, Witt E, Ezzati M, Naghavi M, Murray C.
Lancet. 2014 Jan 18;383(9913):245-54.
Vital signs: Avoidable deaths from heart disease, stroke, and hypertensive disease – United States, 2001-2010External
Schieb , Greer SA, Ritchey D, George MG, Casper ML.
MMWR Morb Mortal Wkly Rep. 2013 Sep 6;62(35):721-7.
The role of public health in promoting quality improvement in care for stroke and heart diseaseExternal
George MG, Matters MD, McGruder HF, Valderrama AL, Xie J.
Prev Chronic Dis. 2008 Apr;5(2):A62.
Guidelines for the prevention of stroke in women: A statement for healthcare professionals from the American Heart Association/American Stroke AssociationExternal
Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, Howard VJ, Lichtman JH, Lisabeth LD, Pina IL, Reeves MJ, Rexrode KM, Saposnik G, Singh V, Towfighi A, Vaccarino V, Walters MR.
Stroke. 2014 May;45(5):1545-88.
Factors influencing the decline in stroke mortality: A statement from the American Heart Association/American Stroke AssociationExternal
Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A.
Stroke. 2014 Jan;45(1):315-53.
Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke AssociationExternal
Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MS, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA.
Stroke. 2014 Dec;45(12):3754-832.
- Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008External
Key Scientific Articles in Selected Topic Areas
Definition and Implications of the Preventable StrokeExternal
Fisher M, Moores L, Alsharif MN, Paganini-Hill A.
JAMA Neurol. 2016 Feb 1;73(2):186-9.
- Definition and Implications of the Preventable StrokeExternal
The names of CDC authors are indicated in bold text.
Articles published in the past 6-8 weeks authored by CDC or ATSDR staff.
The influence of spiritual framing on African American women’s mammography intentions: A randomized trialExternal
Best AL, Spencer SM, Friedman DB, Hall IJ, Billings D.
J Health Commun. 2016 May 4:1-9.
- The influence of spiritual framing on African American women’s mammography intentions: A randomized trialExternal
Assessing efficacy of a retention-in-care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug useExternal
Gardner LI, Marks G, Shahani L, Giordano TP, Wilson TE, Drainoni ML, Keruly JC, Batey DS, Metsch LR.
AIDS. 2016 Apr 24;30(7):1111-9.
Risk factors associated with HIV among men who have sex only with men and men who have sex with both men and women in three urban areas in MozambiqueExternal
Sathane I, Horth R, Young P, Inguane C, Nala R, Miranda AE, Lane T, Raymond HF, Cummings B, McFarland W.
AIDS Behav. 2016 Apr 8.
What happens when “germs don’t get killed and they attack again and again”: Perceptions of antimicrobial resistance in the context of diarrheal disease treatment among laypersons and health-care providers in Karachi, PakistanExternal
Joseph HA, Agboatwalla M, Hurd J, Jacobs-Slifka K, Pitz A, Bowen A.
Am J Trop Med Hyg. 2016 May 2.
Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi KenyaExternal
Muhula S, Memiah P, Mbau L, Oruko H, Baker B, Ikiara G, Mungai M, Ndirangu M, Achwoka D, Ilako F.
BMC Public Health. 2016 ;16(1):373.
Editorial commentary: The modern quest for the “holy grail” of pneumonia etiologyExternal
Jain S, Pavia AT.
Clin Infect Dis. 2016 Apr 1;62(7):826-8.
Hidden and mobile: A web-based study of migration patterns of men who have sex with men in ChinaExternal
Mi G, Ma B, Kleinman N, Li Z, Fuller S, Bulterys M, Hladik W, Wu Z.
Clin Infect Dis. 2016 Apr 29.
New insights into the global burden of noroviruses and opportunities for preventionExternal
Hall AJ, Glass RI, Parashar UD.
Expert Rev Vaccines. 2016 May 3:1-3.
Prognostic implications of baseline anaemia and changes in haemoglobin concentrations with amphotericin B therapy for cryptococcal meningitisExternal
Tugume L, Morawski BM, Abassi M, Bahr NC, Kiggundu R, Nabeta HW, Hullsiek KH, Taseera K, Musubire AK, Schutz C, Muzoora C, Williams DA, Rolfes MA, Meintjes G, Rhein J, Meya DB, Boulware DR.
HIV Med. 2016 Apr 28.
Decline in HIV seroprevalence in street youth 2006-2012, St. Petersburg, Russia: Moving toward an AIDS-free generationExternal
Kornilova MS, Batluk JV, Yorick RV, Baughman AL, Hillis SD, Vitek CR.
Int J STD AIDS. 2016 May 4.
Geographical variation in prevalence of cryptococcal antigenemia among HIV-infected treatment-naive patients in Nigeria: A multicenter cross-sectional studyExternal
Ezeanolue EE, Nwizu C, Greene GS, Amusu O, Chukwuka C, Ndembi N, Smith RM, Chiller T, Pharr J, Kozel TR.
J Acquir Immune Defic Syndr. 2016 May 3.
Botswana’s progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: A population-based surveyExternal
Gaolathe T, Wirth KE, Holme MP, Makhema J, Moyo S, Chakalisa U, Yankinda EK, Lei Q, Mmalane M, Novitsky V, Okui L, van Widenfelt E, Powis KM, Khan N, Bennett K, Bussmann H, Dryden-Peterson S, Lebelonyane R, El-Halabi S, Mills LA, Marukutira T, Wang R, Tchetgen EJ, DeGruttola V, Essex M, Lockman S.
Lancet HIV. 2016 May;3(5):e221-30.
Mathematical models of Ebola – consequences of underlying assumptionsExternal
Feng Z, Zheng Y, Hernandez-Ceron N, Zhao H, Glasser J, Hill A.
Math Biosci. 2016 Apr 26.
Sanitation and hygiene-specific risk factors for moderate-to-severe diarrhea in young children in the Global Enteric Multicenter Study, 2007-2011: Case-control studyExternal
Baker KK, O’Reilly CE, Levine MM, Kotloff KL, Nataro JP, Ayers TL, Farag TH, Nasrin D, Blackwelder WC, Wu Y, Alonso PL, Breiman RF, Omore R, Faruque AS, Das SK, Ahmed S, Saha D, Sow SO, Sur D, Zaidi AK, Quadri F, Mintz ED.
PLoS Med. 2016 May;13(5):e1002010.
Chikungunya fever cases identified in the Veterans Health Administration System, 2014External
Perti T, Lucero-Obusan CA, Schirmer PL, Winters MA, Holodniy M.
PLoS Negl Trop Dis. 2016 May;10(5):e0004630.
- Assessing efficacy of a retention-in-care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug useExternal
Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011External
Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM, Finkelstein JA, Gerber JS, Hyun DY, Linder JA, Lynfield R, Margolis DJ, May LS, Merenstein D, Metlay JP, Newland JG, Piccirillo JF, Roberts RM, Sanchez GV, Suda KJ, Thomas A, Woo TM, Zetts RM, Hicks LA.
JAMA. 2016 May 3;315(17):1864-73.
Hepatotoxicity associated with the dietary supplement OxyELITE Pro – Hawaii, 2013External
Johnston DI, Chang A, Viray M, Chatham-Stephens K, He H, Taylor E, Wong LL, Schier J, Martin C, Fabricant D, Salter M, Lewis L, Park SY.
Drug Test Anal. 2016 Mar;8(3-4):319-27.
- Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011External
Novel exposure biomarkers of N,N-diethyl-m-toluamide (DEET): Data from the 2007-2010 National Health and Nutrition Examination SurveyExternal
Calafat AM, Baker SE, Wong LY, Bishop AM, Morales AP, Valentin-Blasini L.
Environ Int. 2016 Apr 30;92-93:398-404.
Prenatal phthalate exposures and body mass index among 4- to 7-year-old children: A pooled analysisExternal
Buckley JP, Engel SM, Braun JM, Whyatt RM, Daniels JL, Mendez MA, Richardson DB, Xu Y, Calafat AM, Wolff MS, Lanphear BP, Herring AH, Rundle AG.
Epidemiology. 2016 May;27(3):449-58.
Improving health in the Arctic region through safe and affordable access to household running water and sewer services: An Arctic Council initiativeExternal
Hennessy TW, Bressler JM.
Int J Circumpolar Health. 2016 ;75:31149.
- Novel exposure biomarkers of N,N-diethyl-m-toluamide (DEET): Data from the 2007-2010 National Health and Nutrition Examination SurveyExternal
Comparative genomics reveals Cyclospora cayetanensis possesses coccidia-like metabolism and invasion components but unique surface antigensExternal
Liu S, Wang L, Zheng H, Xu Z, Roellig DM, Li N, Frace MA, Tang K, Arrowood MJ, Moss DM, Zhang L, Feng Y, Xiao L.
BMC Genomics. 2016 ;17(1):316.
Validation of a standardized extraction method for formalin-fixed paraffin-embedded tissue samplesExternal
Lagheden C, Eklund C, Kleppe SN, Unger ER, Dillner J, Sundstrom K.
J Clin Virol. 2016 Apr 27;80:36-39.
Reversion to wildtype of a mutated and nonfunctional coxsackievirus B3CRE(2C)External
Smithee S, Tracy S, Chapman NM.
Virus Res. 2016 Apr 26.
- Comparative genomics reveals Cyclospora cayetanensis possesses coccidia-like metabolism and invasion components but unique surface antigensExternal
Payments for opioids shifted substantially to public and private insurers while consumer spending declined, 1999-2012External
Zhou C, Florence CS, Dowell D.
Health Aff (Millwood). 2016 May 1;35(5):824-31.
- Payments for opioids shifted substantially to public and private insurers while consumer spending declined, 1999-2012External
Emergence of azole-resistant Candida parapsilosis causing bloodstream infection: Results from laboratory-based sentinel surveillance in South AfricaExternal
Govender NP, Patel J, Magobo RE, Naicker S, Wadula J, Whitelaw A, Coovadia Y, Kularatne R, Govind C, Lockhart SR, Zietsman IL.
J Antimicrob Chemother. 2016 Apr 28.
Engaging hospitalists in antimicrobial stewardship: Lessons from a multihospital collaborativeExternal
Mack MR, Rohde JM, Jacobsen D, Barron JR, Ko C, Goonewardene M, Rosenberg DJ, Srinivasan A, Flanders SA.
J Hosp Med. 2016 Apr 30.
- Emergence of azole-resistant Candida parapsilosis causing bloodstream infection: Results from laboratory-based sentinel surveillance in South AfricaExternal
Improving capture of vaccine history: Case study from an evaluation of 10-valent pneumococcal conjugate vaccine introduction in KenyaExternal
Harris AM, Aol G, Ouma D, Bigogo G, Montgomery JM, Whitney CG, Breiman RF, Kim L.
Am J Trop Med Hyg. 2016 May 2.
The effect of influenza vaccination on birth outcomes in a cohort of pregnant women in Lao PDR, 2014-2015External
Olsen SJ, Mirza SA, Vonglokham P, Khanthamaly V, Chitry B, Pholsena V, Chitranonh V, Omer SB, Moen A, Bresee JS, Corwin A, Xeuatvongsa A.
Clin Infect Dis. 2016 May 3.
Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccinesExternal
Aliabadi N, Tate JE, Parashar UD.
Clin Microbiol Infect. 2016 Apr 26.
Recommendations and offers for adult influenza vaccination, 2011-2012 season, United StatesExternal
Benedict KM, Kennedy ED, Santibanez TA, Black CL, Ding H, Graitcer SB, Bridges CB.
Vaccine. 2016 Apr 29.
- Improving capture of vaccine history: Case study from an evaluation of 10-valent pneumococcal conjugate vaccine introduction in KenyaExternal
Health information technology adoption in the emergency departmentExternal
Selck FW, Decker SL.
Health Serv Res. 2016 Feb;51(1):32-47.
- Health information technology adoption in the emergency departmentExternal
Primary care opportunities to prevent unintentional home injuries: A focus on children and older adultsExternal
McDonald EM, Mack K, Shields WC, Lee RP, Gielen AC.
Am J Lifestyle Med. 2016 Feb 12;2016.
Lessons learned from implementing CDC’s STEADI falls prevention algorithm in primary careExternal
Casey CM, Parker EM, Winkler G, Liu X, Lambert GH, Eckstrom E.
Gerontologist. 2016 Apr 29.
- Primary care opportunities to prevent unintentional home injuries: A focus on children and older adultsExternal
Safety and pharmacokinetics of quick dissolving polymeric vaginal films delivering the antiretroviral IQP-0528 for pre-exposure prophylaxisExternal
Srinivasan P, Zhang J, Martin A, Kelley K, McNicholl JM, Buckheit RW, Smith JM, Ham AS.
Antimicrob Agents Chemother. 2016 May 2.
A humanized monoclonal antibody neutralizes yellow fever virus strain 17D-204 in vitro but does not protect a mouse model from diseaseExternal
Calvert AE, Dixon KL, Piper J, Bennett SL, Thibodeaux BA, Barrett AD, Roehrig JT, Blair CD.
Antiviral Res. 2016 Apr 25.
Lawsonella clevelandensis gen. nov., sp. nov., a new member of the suborder Corynebacterineae isolated from human abscessesExternal
Bell ME, Bernard KA, Harrington SM, Patel NB, Tucker TA, Metcalfe MG, McQuiston JR.
Int J Syst Evol Microbiol. 2016 Apr 29.
Assessing immunity to rubella virus: A plea for standardization of IgG (immuno)assaysExternal
Bouthry E, Furione M, Huzly D, Ogee-Nwankwo A, Hao L, Adebayo A, Icenogle J, Sarasini A, Revello MG, Grangeot-Keros L, Vauloup-Fellous C.
J Clin Microbiol. 2016 May 4.
Molecular detection of airborne Coccidioides in Tucson, ArizonaExternal
Chow NA, Griffin DW, Barker BM, Loparev VN, Litvintseva AP.
Med Mycol. 2016 May 3.
How should the completeness and quality of curated nanomaterial data be evaluated?External
Marchese Robinson RL, Lynch I, Peijnenburg W, Rumble J, Klaessig F, Marquardt C, Rauscher H, Puzyn T, Purian R, Aberg C, Karcher S, Vriens H, Hoet P, Hoover MD, Hendren CO, Harper SL.
Nanoscale. 2016 May 4.
Reproductive endocrine patterns and volatile urinary compounds of Arctictis binturong: Discovering why bearcats smell like popcornExternal
Greene LK, Wallen TW, Moresco A, Goodwin TE, Drea CM.
Naturwissenschaften. 2016 Jun;103(5-6):37.
Direct stimulation of human fibroblasts by nCeO2 in vitro is attenuated with an amorphous silica coatingExternal
Davidson DC, Derk R, He X, Stueckle TA, Cohen J, Pirela SV, Demokritou P, Rojanasakul Y, Wang L.
Part Fibre Toxicol. 2016 ;13(1):23.
Integration of multiplex bead assays for parasitic diseases into a national, population-based serosurvey of women 15-39 years of age in CambodiaExternal
Priest JW, Jenks MH, Moss DM, Mao B, Buth S, Wannemuehler K, Soeung SC, Lucchi NW, Udhayakumar V, Gregory CJ, Huy R, Muth S, Lammie PJ.
PLoS Negl Trop Dis. 2016 May;10(5):e0004699.
- Safety and pharmacokinetics of quick dissolving polymeric vaginal films delivering the antiretroviral IQP-0528 for pre-exposure prophylaxisExternal
Role of antibiotics in reducing childhood mortality in resource-poor settingsExternal
Kourtis AP, Jamieson DJ, Chasela C, van der Horst C.
AIDS. 2016 May 15;30(8):1310-1.
Lactation and maternal cardio-metabolic healthExternal
Perrine CG, Nelson JM, Corbelli J, Scanlon KS.
Annu Rev Nutr. 2016 May 4.
- Role of antibiotics in reducing childhood mortality in resource-poor settingsExternal
Shiftwork and diurnal salivary cortisol patterns among police officersExternal
Charles LE, Fekedulegn D, Burchfiel CM, Hartley TA, Andrew ME, Violanti JM, Miller DB.
J Occup Environ Med. 2016 Apr 27.
- Shiftwork and diurnal salivary cortisol patterns among police officersExternal
Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995-2012External
Painter JE, Gargano JW, Yoder JS, Collier SA, Hlavsa MC.
Epidemiol Infect. 2016 Jun;144(8):1792-802.
Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan AfricaExternal
Theiss-Nyland K, Lynch M, Lines J.
Malar J. 2016 ;15(1):255.
A public health paradox: The women most vulnerable to malaria are the least protectedExternal
Gonzalez R, Sevene E, Jagoe G, Slutsker L, Menendez C.
PLoS Med. 2016 May;13(5):e1002014.
Symptoms and immune markers in Plasmodium/dengue virus co-infection compared with mono-infection with either in PeruExternal
Halsey ES, Baldeviano GC, Edgel KA, Vilcarromero S, Sihuincha M, Lescano AG.
PLoS Negl Trop Dis. 2016 Apr;10(4):e0004646.
- Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995-2012External
Four aspects of the scope and quality of family planning services in US publicly-funded health centers: Results from a survey of health center administratorsExternal
Carter MW, Gavin L, Zapata LB, Bornstein M, Mautone-Smith N, Moskosky SB.
Contraception. 2016 Apr 25.
- Four aspects of the scope and quality of family planning services in US publicly-funded health centers: Results from a survey of health center administratorsExternal
Descriptive epidemiology of somatising tendency: Findings from the CUPID studyExternal
Vargas-Prada S, Coggon D, Ntani G, Walker-Bone K, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Kadir MM, Warnakulasuriya SS, Matsudaira K, Nyantumbu B, Sim MR, Harcombe H, Cox K, Sarquis LM, Marziale MH, Harari F, Freire R, Harari N, Monroy MV, Quintana LA, Rojas M, Harris EC, Serra C, Martinez JM, Delclos G, Benavides FG, Carugno M, Ferrario MM, Pesatori AC, Chatzi L, Bitsios P, Kogevinas M, Oha K, Freimann T, Sadeghian A, Peiris-John RJ, Sathiakumar N, Wickremasinghe AR, Yoshimura N, Kelsall HL, Hoe VC, Urquhart DM, Derrett S, McBride D, Herbison P, Gray A, Vega EJ.
PLoS One. 2016 ;11(4):e0153748.
- Descriptive epidemiology of somatising tendency: Findings from the CUPID studyExternal
Secondhand smoke exposure and susceptibility to initiating cigarette smoking among never-smoking students in selected African countries: Findings from the Global Youth Tobacco SurveyExternal
Lee KA, Palipudi KM, English LM, Ramanandraibe N, Asma S.
Prev Med. 2016 Apr 29.
- Secondhand smoke exposure and susceptibility to initiating cigarette smoking among never-smoking students in selected African countries: Findings from the Global Youth Tobacco SurveyExternal
Sennetsu neorickettsiosis, spotted fever group, and typhus group rickettsioses in three provinces in ThailandExternal
Bhengsri S, Baggett HC, Edouard S, Dowell SF, Dasch GA, Fisk TL, Raoult D, Parola P.
Am J Trop Med Hyg. 2016 May 2.
The development of small animal models for Zika virus vaccine efficacy testing and pathological assessmentExternal
Brault AC, Bowen RA.
Am J Trop Med Hyg. 2016 May 2.
Zika virus disease in travelers returning to the United States, 2010-2014External
Hennessey MJ, Fischer M, Panella A, Kosoy O, Laven J, Lanciotti RS, Staples JE.
Am J Trop Med Hyg. 2016 May 2.
Bayesian spatiotemporal pattern and eco-climatological drivers of striped skunk rabies in the north central plainsExternal
Raghavan RK, Hanlon CA, Goodin DG, Davis R, Moore M, Moore S, Anderson GA.
PLoS Negl Trop Dis. 2016 Apr;10(4):e0004632.
- Sennetsu neorickettsiosis, spotted fever group, and typhus group rickettsioses in three provinces in ThailandExternal
CDC Science Clips Production Staff:
- John Iskander, MD MPH, Editor
- Jane Gidudu, MD, MPH, Acting Editor
- Gail Bang, MLIS, Librarian
- William (Bill) Thomas, MLIS, Librarian
- Kathleen Connick, MSLS, Librarian
- Jarvis Sims, MIT, MLIS, Librarian
- Mathieu Mazarin, MASc, Web Developer/Designer
DISCLAIMER: Articles listed in the CDC Science Clips are selected by the Stephen B. Thacker CDC Library to provide current awareness of the public health literature. An article’s inclusion does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article’s methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.