What will it take to eliminate hepatitis B as a public health threat in the United States and Canada?

Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak - United States, December 31, 2019-February 4, 2020.

US public health resources for coronavirus disease 2019 that are relevant to allergy-immunology

Embedding Racial Justice and Advancing Health Equity at the American Medical Association

To consolidate recent information on elimination and eradication goals for infectious diseases and clarify the definitions and associated terminology for different goals. We conducted a systematic search of the World Health Organization's Institutional Repository for Information Sharing (WHO IRIS) and a customized systematic Google advanced search for documents published between 2008 and 2022 on elimination or eradication strategies for infectious conditions authored by WHO or other leading health organizations. We extracted information on names of infectious conditions, the elimination and eradication goals and timelines, definitions of goals, non-standardized terminology, targets and assessment processes. We identified nine goals for 27 infectious conditions, ranging from disease control to eradication. In comparison with the hierarchy of disease control, as defined at the Dahlem Workshop in 1997, six goals related to disease control with varying levels of advancement, two related to elimination and one to eradication. Goals progressed along a disease-control continuum, such as end of disease epidemic to pre-elimination to elimination as a public health problem or threat. We identified the use of non-standardized terminology with certain goals, including virtual elimination, elimination of disease epidemics, public health threat and public health concern. As we approach the 2030 target date to achieve many of the goals related to disease control and for other infections to become candidates for elimination in the future, clarity of definitions and objectives is important for public health professionals and policy-makers to avoid misperceptions and miscommunication.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Susło A, Mizia S, Pochybełko E, Horoch-Łyszczarek E. Loneliness among elderly people as a public health threat. Family Medicine & Primary Care Review. 2023;25(1):107-110. doi:10.5114/fmpcr.2023.126026. APA Susło, A., Mizia, S., Pochybełko, E., & Horoch-Łyszczarek, E. (2023). Loneliness among elderly people as a public health threat. Family Medicine & Primary Care Review, 25(1), 107-110. https://doi.org/10.5114/fmpcr.2023.126026 Chicago Susło, Anna, Sylwia Mizia, Ewa Pochybełko, and Ewa Horoch-Łyszczarek. 2023. "Loneliness among elderly people as a public health threat". Family Medicine & Primary Care Review 25 (1): 107-110. doi:10.5114/fmpcr.2023.126026. Harvard Susło, A., Mizia, S., Pochybełko, E., and Horoch-Łyszczarek, E. (2023). Loneliness among elderly people as a public health threat. Family Medicine & Primary Care Review, 25(1), pp.107-110. https://doi.org/10.5114/fmpcr.2023.126026 MLA Susło, Anna et al. "Loneliness among elderly people as a public health threat." Family Medicine & Primary Care Review, vol. 25, no. 1, 2023, pp. 107-110. doi:10.5114/fmpcr.2023.126026. Vancouver Susło A, Mizia S, Pochybełko E, Horoch-Łyszczarek E. Loneliness among elderly people as a public health threat. Family Medicine & Primary Care Review. 2023;25(1):107-110. doi:10.5114/fmpcr.2023.126026.

Why would a journal that tracks and analyzes emerging infectious disease trends devote an entire issue to tuberculosis, a disease that emerged some 15,000 to 35,000 years ago (1,2)? The disturbing answer is that tuberculosis is reappearing in many countries as a public health crisis. Thus, if not an emerging disease, it is an important reemerging disease, and though ancient, it is not a disease of the past. A staggering 1.9 million around the globe die of tuberculosis each year—another 1.9 billion are infected with M. tuberculosis and are at risk for active disease (3). In the 20th century, the United States made impressive strides in tuberculosis control. From the early 1900s, when some areas began systematic reporting of death rates, tuberculosis rates steadily declined from approximately 200 deaths per 100,000 per year to less than 1 death per 100,000 in 1985. In 1953, a national surveillance system was established for reporting new cases of tuberculosis disease; that year, reported annual incidence was 53 cases per 100,000 population (4). From 1953 to 1984, tuberculosis disease incidence dropped steadily at an average rate of 5.8% per year to 9.4 cases per 100,000. In 1985, however, the United States saw a reversal in this long-standing downward trend, and tuberculosis reemerged as a public health threat. From 1985 to 1992, not only did the number of cases increase from 22,201 to 26,673, but also large outbreaks were reported. Many of these, especially in hospitals and other health-care settings in large cities (5), were caused by multidrug-resistant M. tuberculosis. Several factors contributed to this increase, including the emergence of the HIV epidemic and large influxes of immigrants from countries in which tuberculosis was common. Perhaps the major reason for the reemergence, however, was the end in 1972 of categorical federal funding for control activities and the subsequent deterioration of public health infrastructure for tuberculosis. In response to the crisis of reemerging tuberculosis, categorical grants were restored and federal funding was increased. The funding, modest at first, rose sharply in 1992 and again in 1993 and 1994. The Centers for Disease Control and Prevention (CDC) transfers most of its appropriated funds to tuberculosis control programs in states and large cities through cooperative agreements. These funds support clinics and laboratories, administer directly observed therapy, intensify investigation of latent infection in persons at high risk for active disease, sponsor clinical and epidemiologic research, and expand surveillance to monitor the impact of these efforts. Renewed investments paid off, and after a peak in 1992, tuberculosis incidence in the United States has declined each year. From 1992 to 2001, the annual decline averaged 7.3%, even greater than before 1985. But future success is not guaranteed. The National Academy of Sciences Institute of Medicine, in its 2000 report on tuberculosis control efforts in the United States, warned against the “complacency and neglect” that come with declining numbers of cases and reaffirmed the goal of TB elimination (annual incidence of >1 case per 1,000,000 population) in the United States (6). In 2001, the 15,989 tuberculosis cases reported to CDC represented only a 2% decline from 2000, the smallest decline in 9 years. Although data from a single year do not constitute a trend, these numbers may be the first sign of stagnation in our control efforts. The proportion of cases in persons born outside the United States is growing; in 2001, that figure reached 50%. Efforts to reduce tuberculosis transmission in the United States have little effect on reducing risk for those infected elsewhere. The proportion of cases in persons born in other countries will probably continue to rise, unless domestic programs providing tuberculosis services for immigrants are strengthened and international programs are expanded. Another risk, in the current climate of bioterrorism, is the possible intentional spread of multidrug-resistant M. tuberculosis. This risk requires new tools for detection and rapid and effective response. Currently strengthened surveillance systems closely monitor changes in disease epidemiology. If tuberculosis elimination progress in the United States slows, we are prepared to respond quickly.

BackgroundDue to high disease burden and poor animal health services in Uganda, administration of antimicrobials particularly oxytetracycline (OTC) is often done by farm owners and workers without any prescription. This results in misuse of OTC with consequent high chances of antibiotic residues and antimicrobial resistance hence posing public health threat. The degree of public health threat from OTC use is not well established due to limited published data on antibiotic residues and usage in livestock production in Uganda. This study comparatively determined OTC residue levels in 318 samples of bovine muscles, liver and kidney tissues from Kiruhura, Mbarara and Ntungamo districts of South Western Uganda during dry and wet seasons.ResultsThe results revealed that the overall OTC residues positivity levels was 74.84% while the district wise rates were 56.88%, 84% and 84.52% for Kiruhura, Mbarara and Ntungamo, respectively. The mean OTC residue levels in bovine muscles, liver and kidney tissues were above the recommended maximum residue limits of 200, 600 and 1200 µg/kg, respectively as established by FAO/WHO. Of the collected samples, 72.41% (236/318) had OTC residues in concentrations above the recommended maximum residue limits. Wilcoxon signed rank test results showed that change in the seasons did not cause any significant changes in the liver OTC residue levels for all the districts, though this was significant for muscles from Kiruhura and Mbarara districts. Unacceptably high OTC levels were found in the muscles, liver and some kidney samples: Kiruhura muscles and liver samples had mean OTC concentrations of 1094 ± 378 µg/kg and 967 ± 198 µg/kg; Mbarara muscles, liver and kidney samples had mean OTC mean concentrations of 668 ± 163 µg/kg, 3778 ± 1140 µg/kg and 12,576 ± 1630 µg/kg, respectively while Ntungamo samples had mean OTC concentrations of 586 ± 123 µg/kg and 5194 ± 1463 µg/kg in muscle and liver tissues.ConclusionsThe results of this study indicated that there are unacceptably high OTC residue levels in bovine tissues consumed in South Western Uganda. This poses a public and veterinary health threat to consumers of these bovine tissues.

The societal cost of Taenia solium cysticercosis in Tanzania

The re-emergence of measles in developed countries: Time to develop the next-generation measles vaccines?

Everyone’s Problem

Can U.S. Immigration Law Be Reconciled with the Protection of Public Health?

ABSTRACTAccurate estimates of the prevalence of chronic hepatitis B virus (HBV) in the United States (US) are necessary for policy makers and community‐based organisations to make informed decisions regarding the allocation of resources to work towards the elimination of HBV as a public health threat. The primary aim of this study was to quantify the current HBV prevalence in the US at the state, county, and territorial level. The secondary aim was to quantify which countries of birth lead HBV infections. Using previously validated and published population‐based country level Markov models, the prevalence of HBV among immigrants in the US by country of birth was estimated in 2021. These estimates were then applied to county level population estimates from the 2018–2022 American Community Survey. This resulted in new county, state, territorial (Puerto Rico and Washington, D.C.), and national level HBV prevalence estimates. The total number of HBV infections in the US was estimated to be 1.7 million (UI: 795,000–4.1 million) corresponding to a prevalence of 0.50% (UI: 0.24%–1.23%). The state with the highest prevalence was Hawai‘i, 1.3% (UI: 0.5%–40%), while Wyoming was estimated to have the lowest prevalence, 0.2% (UI: 0.1%–1.1%). The largest number of total infections was found in California, 347,100 (UI: 193,700–729,200). The Aleutians West Census Area was the county with the highest prevalence, 2.9% (UI: 0.8%–9.7%), while Los Angeles County had the highest number of infections, 96,700 (UI: 54,800–190,600). These data can aid planners at all levels to better understand the complexities of HBV in the US. Thus, providing evidence for targeted public health interventions that will reduce the burden of HBV and improve the lives of those living with the disease.

Mandating Comprehensive Eye Examinations for Children: Where Is the Evidence?

Web ExclusivesMarch 2023Annals for Educators - March 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202303210 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsImplantable Defibrillator System Shock Function, Mortality, and Cause of Death After Magnetic Resonance ImagingData on the ability of non–MRI-conditional implantable cardioverter-defibrillators (ICDs) to terminate arrhythmias after MRI have been limited. This study examines whether non–MRI-conditional ICDs have preserved shock function of arrhythmias after an average of 2 years of follow-up after MRI.Use this article to:Review the indications for ICD placement.Invite a cardiologist to your session to teach about the different types of ICDs and how to tell whether a patient has a device that is non–MRI-conditional.Discuss how this article could be helpful in assuring patients with ICDs that it is OK for them to get an MRI if they need one.Long-Term Changes in the Size of Pituitary MicroadenomasPituitary lesions found on brain imaging that is done for other purposes are often called “incidentalomas,” and most are microadenomas with diameters less than 10 mm. Little is known about how stable these microadenomas are and how often they should be imaged. This article provides new information about the stability of pituitary microadenomas.Use this article to:Invite a radiologist to your session to review pituitary microadenomas detected on MRI.Discuss the currently recommended surveillance strategy for pituitary incidentalomas and whether the results of the study suggest that changes in the surveillance recommendations are indicated.Invite an endocrinologist to your session to review the indications for intervention of a pituitary microadenoma.Risk Model–Based Lung Cancer Screening. A Cost-Effectiveness AnalysisSelecting Candidates for Lung Cancer Screening: Implications for Effectiveness, Efficiency, Equity, and ImplementationThis study showed that risk model–based lung cancer screening approaches are more cost-effective than selecting people by using the 2021 categorical age smoking criteria from the U.S. Preventive Services Task Force (USPSTF). The accompanying editorial discusses why we cannot assume model results will be replicable in clinical practice and the need to overcome barriers to balancing tradeoffs in effectiveness, efficiency, and equity.Use this article and the editorial to:Review the current USPSTF recommendations for lung cancer screening.Discuss the potential harms associated with lung cancer screening.Invite a pulmonologist to your session to discuss the appropriate next steps if a pulmonary lesion is identified during lung cancer screening of an asymptomatic patient.Ask your learners to discuss what cost-per-QALY threshold policymakers should use to identify a “cost-effective” intervention.Planning for Mpox on a College Campus: A Model-Based Decision-Support ToolIn the current global outbreak of mpox, it is important to model how human-to-human transmission could occur in congregate settings and how to mitigate spread. This study estimated the likelihood of an mpox outbreak and the potential effect of mitigation measures in a residential college setting.Use this article to:Review the clinical presentation of mpox.Discuss the indications for vaccination to reduce the risk for mpox and the procedures for arranging vaccination at your institution.Review pharmacologic therapy for mpox and the procedures for arranging therapy at your institution.Discuss how you would counsel a patient to reduce the risk for transmission of infection to others.Symptom and Viral Rebound in Untreated SARS-CoV-2 InfectionThere have been reports of rebound of SARS-CoV-2 and symptoms after receipt of nirmatrelvir–ritonavir for treatment of COVID-19. Using prospectively obtained data from patients receiving placebo in a large COVID-19 “platform” trial, this study investigated the natural history of rebound in the absence of antiviral therapy.Use this article to:Review the indications for using nirmatrelvir–ritonavir to treat COVID-19. This article will help guide the discussion. Ask your learners whether they think this study provides convincing evidence that rebound is a feature of COVID-19 and not something associated with treatment with nirmatrelvir–ritonavir.Discuss how the findings of this study could be used to help convince patients to accept treatment if they are reluctant to take nirmatrelvir–ritonavir because they have heard stories about rebound.Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes. A Systematic Review and Meta-analysis of Individual Participant Data From 3 Randomized Clinical TrialsPreventing Type 2 Diabetes With Vitamin D: Therapy Versus SupplementationThis systematic review and individual patient data meta-analysis synthesized 3 randomized controlled trials of vitamin D to prevent diabetes in persons with prediabetes. The accompanying editorial discusses the findings and emphasizes the important differences between supplementation and therapy.Use this article and the editorial to:Watch the brief video summarizing the systematic review with your learners. Review the definition of “prediabetes”.Discuss the appropriate dose of vitamin D supplementation.Review the important difference between supplementation and therapy that the editorial highlights.Ask your learners whether the findings of this review motivate them to recommend vitamin D to patients with prediabetes.Reproductive Health Policy in the United States: An American College of Physicians Policy BriefSince the U.S. Supreme Court decision in Dobbs v Jackson Women's Health Organization, some state governments have imposed stringent restrictions on abortion, whereas others have sought to protect access. In this paper, the American College of Physicians updates its previous positions to reflect this new reality and offers recommendations to promote equitable access to reproductive health care services and safeguard maternal health.Use this article to:Review the current policies on contraception and abortion in the state where your learners practice.Ask your learners whether the current policies would make them hesitant to refer a patient for abortion.Review the options for referral of a patient for abortion at your institution.Discuss the potential implications of state restrictions on reproductive health care for other health situations. This commentary, this commentary, and this commentary can help prompt discussion. Recommended Adult Immunization Schedule, United States, 2023This article provides immunization recommendations from the Advisory Committee on Immunization Practices (ACIP) for adults aged 19 years or older. The purpose of the immunization schedule is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations.Use this article to:Invite a colleague from nursing to your session to demonstrate the proper technique for administering an intramuscular vaccine.Review the changes in the ACIP vaccine recommendations between 2022 and 2023.Ask your learners to share strategies they find helpful in discussing vaccination with patients who are hesitant to receive it. This article may help to stimulate the discussion. Public HealthFirearm Injury: An Escalating Health CrisisAn estimated 50 000 people in the United States lost their lives to guns in 2021. An infectious organism responsible for that many deaths would clearly be considered a public health threat, and that is why the American College of Physicians sees gun injury as a public health issue. Reducing the negative impact of guns on the health of the U.S. public requires multidisciplinary efforts involving government, law enforcement, gun manufacturers, and others; health care professionals also have an important role. On 11 January 2023, Annals of Internal Medicine and the American College of Physicians gathered a panel of experts to discuss what health care professionals can do to reduce the adverse effect of guns on the health of their patients.Use this article to:Watch the video of the program with your learners. Stop the video after the presentation of each clinical scenario and ask your learners how they would approach the situation.Ask your learners whether they agree that firearm injury in the United States is a public health issue.Review the policy recommendations from the American College of Physicians for reducing firearm injury. Ask your learners to discuss whether they agree that physicians have a role in reducing firearm injury. If so, what is that role?Cardiac AmyloidosisAmyloidosis is a pathologic and clinical condition resulting from the accumulation of misfolded proteins in tissues. Extracellular deposition of amyloid fibrils in the myocardium leads to cardiac amyloidosis, which is often overlooked as a cause of restrictive cardiomyopathy. Cardiac amyloidosis was previously believed to have a poor prognosis, but recent advances in diagnosis and treatment have emphasized the importance of early recognition and changed management of this important and often underrecognized clinical condition. This review provides an overview of cardiac amyloidosis and summarizes current screening, diagnosis, evaluation, and treatment options.Use this article to:Discuss the presentation of cardiac amyloidosis.Ask your learners if they have any patients with cardiac amyloidosis. How was it diagnosed?Review the complications of untreated cardiac amyloidosis.Review the available therapeutic strategies for treating cardiac amyloidosis.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current IssueMarch 2023Volume 176, Issue 3 ePublished: 21 March 2023 Issue Published: March 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. 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West Nile Virus Knowledge among Hispanics, San Diego County, California, USA, 2006