Centers For Disease Control Research Articles

Characteristics of Global Rapid Response Team Deployers and Deployment, United States, 2019-2022.

The Centers for Disease Control and Prevention's (CDC's) Global Rapid Response Team (GRRT) was created in 2015 to efficiently deploy multidisciplinary CDC experts outside the United States for public health emergencies. The COVID-19 pandemic dramatically increased the need for domestic public health responders. This study aimed to follow up on previously published data to describe the GRRT surge staffing model during the height of the COVID-19 response. We conducted descriptive analyses to assess GRRT deployment characteristics during April 1, 2019-March 31, 2022, and characteristics of responders rostered in 2021 and 2022. We analyzed data on response events, remote versus in-person work, and international versus domestic deployment location. We also examined the number of responders on call per month, language proficiency, and technical skills. During the study period, 1725 deployments were registered, accounting for 82 058 person-days deployed. Of all person-days deployed during the study period, 82% were related to COVID-19. Eighty-seven percent of all person-days deployed were domestic. Virtual deployments that were not in person accounted for 51% of deployments registered, yet these resulted in 67% of person-days deployed. The median deployment duration was 31 days. We found a median of 79 surge responders on call each month. Among 608 responders rostered in 2021 and 2022, 35% self-reported proficiency in a second language. Epidemiology was the most common technical skill (38%). GRRT transitioned to primarily remote, domestic deployments to support the COVID-19 pandemic response. The GRRT model demonstrates how response structure shifted to address the global health threat of a pandemic.

Examining the Relationship Between Local Governmental Expenditures on the Social Determinants of Health and County-Level Overdose Deaths, 2017-2020.

Prior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories. To examine the association of local governmental investments in SDOH with drug overdose mortality at the county level, controlling for demographic and socioeconomic characteristics. Longitudinal analysis from 2017 to 2020. United States counties. 3126 counties. The primary study outcome was county overdose death rates per 100000 population taken from the Centers for Disease Control and Prevention. The main predictor of interest was the per capita average of local governmental expenditures in public health, social service, and education drawn from the U.S. Census of Governments, categorized into quartiles. Covariates included county-level socioeconomic and demographic characteristics as well as county-level SUD services from the AHRQ SDOH Database. In longitudinal multivariate linear regression models with state and year fixed effects, counties in the highest 3 quartiles of SDOH spending had significantly lower rates of overdose deaths compared with counties in the lowest quartile of SDOH spending; in particular, counties in quartile 2 had an average of 9.09 fewer overdose deaths per 100000 population (95% CI: -12.58, -5.60), counties in quartile 3 had an average of 13.18 fewer deaths per 100000 population (95% CI: -17.56; -8.80), and counties in quartile 4 had an average of 13.92 deaths per 100000 population (95% CI: -19.16, -8.68). Our findings demonstrate that higher levels of local governmental investments in SDOH were associated with significantly lower rates of overdose death in U.S. counties after controlling for socioeconomic and demographic characteristics. Going forward, research should focus on determining causality in this relationship, the mechanisms through which this relationship occurs, as well as assess the impact of local public health expenditures allocated toward SUD prevention and treatment specifically on substance use outcomes at the local level.

A comparative analysis of the Trauma and Injury Severity Score and the Injury Severity Score in predicting high-value care outcomes in children with traumatic brain injury.

Predicting high-value care outcomes is crucial in managing pediatric traumatic brain injuries (TBIs), where timely and accurate prognostication can significantly influence treatment decisions and resource allocation. This study aimed to enhance understanding of how well scoring systems such as the Trauma and Injury Severity Score (TRISS) can forecast high-value care outcomes. Furthermore, the authors compared the predictive power of TRISS with the routinely used Injury Severity Score (ISS). The authors performed a retrospective review of their institutional database from June 2016 to June 2023 to identify cases of TBI based on a modified Centers for Disease Control and Prevention framework. Prolonged length of stay (LOS) was defined as a hospital stay falling into the upper quartile of the overall cohort. Discharge to an inpatient rehabilitation facility, acute care hospital, or foster care or death was defined as a nonroutine discharge disposition. Emergency department (ED) transfer to the intensive care unit (ICU) or operating room (OR) was defined as a proxy for severity of injuries. Multivariate logistic regression models were used to explore the association between ISS, TRISS, and high-value care outcomes. The DeLong test was used to assess the differences between the areas under the receiver operating characteristic curve (AUROCs). This study included 2705 patients with a mean age ± SD of 7.28 ± 5.46 years (63% male). In the overall cohort, 28% experienced prolonged LOS, 7% had a nonroutine discharge disposition from the hospital, and 23% were transferred to the ICU/OR from the ED. In multivariate regression models, both TRISS and ISS were correlated with higher odds of prolonged LOS, nonroutine discharge disposition, and transfer to the ICU/OR from the ED (all p < 0.001). TRISS had a significantly greater AUROC than ISS for nonroutine discharge disposition (0.883 vs 0.849, p < 0.001) and transfer to the ICU/OR (0.898 vs 0.887, p = 0.045), but this result was not significant for prolonged LOS (0.873 vs 0.880, p = 0.140). TRISS and ISS are effective tools for predicting high-value care outcomes in pediatric TBI. Utilizing these resources can assist healthcare providers in making informed, risk-adjusted predictions.

Development, validation, and clinical assessment of a liquid chromatography-tandem mass spectrometry serum assay for per- and polyfluoroalkyl substances (PFAS) recommended by the National Academies of Science, Engineering, and Medicine (NASEM).

Per- and polyfluoroalkyl substances (PFAS) are widely used in industry, residential, and consumer products. Studies have shown associations between high PFAS exposure and adverse health effects. In 2022, the National Academies of Science, Engineering, and Medicine (NASEM) published Guidance on PFAS Exposure, Testing, and Clinical Follow-up providing laboratory and clinical direction. The Guidance suggests nine PFAS should be measured in serum or plasma specimens and summed to provide a total PFAS concentration using a NASEM-recommended method. Follow-up clinical recommendations are based on the calculated PFAS NASEM summation. We developed and validated a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method in accordance with NASEM recommendations but distinguished by the ability to separate closely related structural isomers. As part of our validation, PFAS prevalence was evaluated in a population survey comprised of clinical donor and remnant specimens (n = 1023 in total). In this study, 82.2% of the specimens had PFAS NASEM summations of 2 to < 20ng/mL and 2.5% had a summation ≥ 20ng/mL. The median PFAS NASEM summation was 4.65ng/mL in this study, lower than the 7.74ng/mL median observed in the 2017-2020 Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey (n = 3072). This lower median PFAS NASEM summation may reflect a decline in PFAS population levels over time or sample population exposure differences.

Recent increase in Candida auris frequency in the SENTRY surveillance program: antifungal activity and genotypic characterization.

We observed an increase in the frequency of Candida auris among invasive candidiasis isolates in the 2022 SENTRY Antifungal Surveillance Program compared to prior years: ≤0.1% before 2018, 0.4%-0.6% from 2018 to 2021, and 1.6% in 2022. C. auris isolates were collected in seven countries, but 28 (35.9%) isolates were recovered in the USA (five states; more common in New York, Texas, and New Jersey) and 26 (33.3%) in Panama. Greece and Turkey had 12 and 9 isolates, respectively. Overall, 82.1% of the isolates were resistant to fluconazole; 17.9% were resistant to amphotericin B; and 1.3% were resistant to caspofungin, anidulafungin, or micafungin (Centers for Disease Control and Prevention tentative resistance breakpoints). Rezafungin inhibited 96.2% of the isolates (Clinical and Laboratory Standards Institute susceptibility breakpoint). Pandrug resistance was not observed, but 17.9% of the isolates were resistant to fluconazole and amphotericin B. South Asian (Clade I) isolates were most common (n = 40, 51.3%); of these, 97.5% were resistant to fluconazole and 30.0% were resistant to amphotericin B. Thirty (38.5%) isolates belonged to the South American region (Clade IV), and 56.7% of those were resistant to fluconazole and 6.7% to amphotericin B. Seven isolates belonged to the South African Clade III and one to East Asian Clade II. Erg11 (Y132F, K143R, and F126L) and MRR1 (N647T) alterations were detected. One isolate that was resistant to all echinocandins carried an FKS R1354G alteration. Two isolates displayed elevated rezafungin minimum inhibitory concentration (MIC) values but low MIC values against other echinocandins and no FKS alterations. As C. auris is spreading globally, monitoring this species is prudent.

Pipe material and natural organic matter impact drinking water biofilm microbial community, pathogen profiles and antibiotic resistome deciphered by metagenomics assembly

Biofilms in drinking water distribution systems (DWDSs) are a determinant to drinking water biosafety. Yet, how and why pipe material and natural organic matter (NOM) affect biofilm microbial community, pathogen composition and antibiotic resistome remain unclear. We characterized the biofilms’ activity, microbial community, antibiotic resistance genes (ARGs), mobile genetic elements (MGEs) and pathogenic ARG hosts in Centers for Disease Control and Prevention (CDC) reactors with different NOM dosages and pipe materials based on metagenomics assembly. Biofilms in cast iron (CI) pipes exhibited higher activity than those in polyethylene (PE) pipes. NOM addition significantly decreased biofilm activity in CI pipes but increased it in PE pipes. Pipe material exerted more profound effects on microbial community structure than NOM. Azospira was significantly enriched in CI pipes and Sphingopyxis was selected in PE pipes, while pathogen (Ralstonia pickettii) increased considerably in NOM-added reactors. Microbial community network in CI pipes showed more edges (CI 13520, PE 7841) and positive correlation proportions (CI 72.35%, PE 61.69%) than those in PE pipes. Stochastic processes drove assembly of both microbial community and antibiotic resistome in DWDS biofilms based on neutral community model. Bacitracin, fosmidomycin and multidrug ARGs were predominant in both PE and CI pipes. Both pipe materials and NOM regulated the biofilm antibiotic resistome. Plasmid was the major MGE co-existing with ARGs, facilitating ARG horizontal transfer. Pathogens (Achromobacter xylosoxidans and Ralstonia pickettii) carried multiple ARGs (qacEdelta1, OXA-22 and aadA) and MGEs (integrase, plasmid and transposase), which deserved more attention. Microbial community contributed more to ARG change than MGEs. Structure equation model (SEM) demonstrated that turbidity and ammonia affected ARGs by directly mediating Shannon diversity and MGEs. These findings might provide a technical guidance for controlling pathogens and ARGs from the point of pipe material and NOM in drinking water.

Increased proportions of invasive pneumococcal disease cases amongs adults experiencing homelessness sets stage for new serotype 4 capsular-switch recombinant.

The Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs) identified increased serotype 4 invasive pneumococcal disease (IPD), particularly among adults experiencing homelessness (AEH). We quantified IPD cases during 2016-2022. Employing genomic-based characterization of IPD isolates, we identified serotype-switch variants. Recombinational analyses were used to identify the genetic donor and recipient strains that generated a serotype 4 progeny strain. We performed phylogenetic analyses of the serotype 4 progeny and serotype 12F genetic recipient to determine genetic distances. We identified 30 inter-related (0-21 nucleotide differences) IPD isolates recovered during 2022-2023, corresponding to a serotype 4 capsular-switch variant. This strain arose through a multi-fragment recombination event between serotype 4/ST10172 and serotype 12F/ST220 parental strains. Twenty-five of the 30 cases occurred within Oregon. Of 29 cases with known residence status, 16 occurred in AEH. Variant emergence coincided with a 2.6-fold increase (57 to 148) of cases caused by the serotype 4/ST10172 donor lineage in 2022 compared to 2019 and its first appearance in Oregon. Most serotypes showed sequential increases of AEH IPD/all IPD ratios during 2016-2022 (for all serotypes combined, 247/2198, 11.2% during 2022 compared to 405/5317, 7.6% for 2018-2019, p<0.001). Serotypes 4 and 12F each caused more IPD than any other serotypes in AEH during 2020-2022 (207 combined reported cases primarily in 4 western states accounting for 38% of IPD in AEH). Expansion and increased transmission of serotypes 4 and 12F among adults potentially led to recent genesis of an impactful hybrid "serotype-switch" variant.

A study on the diversity of phlebotomine sand flies (Diptera, Psychodidae) in karstic limestone areas in Vientiane Province, Laos, with a description of two new species of Sergentomyia França and & Parrot

BackgroundSoutheast Asia is well known as a hotspot of biodiversity. However, very little is known about cave-dwelling hematophagous insects that are medically important. Taxonomic knowledge and ecology of phlebotomine sand flies are very poorly studied in Laos, as well as in other countries in the region. Herein, we report species diversity data and some notes on the ecology of the detected species from these karstic limestone areas of Laos.MethodsPhlebotomine sand flies were collected using Centers for Disease Control and Prevention (CDC) light traps from limestone cave locations in three districts of Vientiane Province, Laos. Both morphological and molecular techniques were used for sand fly identification. Species diversity and abundance were analyzed according to sites, locations, collection seasons, and trapping positions.ResultsA total of 6564 sand flies, of which 5038 were females and 1526 were males, were morphologically identified into 20 species belonging to five genera (Chinius, Idiophlebotomus, Phlebotomus, Sergentomyia, and Grassomyia). The most abundant species were Chinius eunicegalatiae, Phlebotomus stantoni, Sergentomyia hivernus, Se. siamensis, and Idiophlebotomus longiforceps. Cytochrome b analysis results supported the morphological identification and revealed that Se. siamensis was separated from other members of the Se. barraudi group. Two new species, Se. dvoraki n. sp. and Se. marolii n. sp., were described. Sand fly density was generally high except in a cave in Vangvieng, with species richness ranging from 14 to 18 across different caves. Outside caves had higher species richness (R = 20) and diversity (H = 2.50) than cave entrances (R = 18, H = 2.41) and interiors (R = 16, H = 2.13). Seasonal variations showed high sand fly density in Feung and Hinheup during both dry and rainy seasons, while Vangvieng had a notable decrease in density during the dry season (D = 6.29).ConclusionsThis study revealed that the diversity of phlebotomine sand fly fauna in Laos, particularly in karstic limestone areas, is greater than previously known. However, the taxonomic status of many species in Laos, as well as Southeast Asia, still needs more in-depth study using both morphological characters and molecular methods. Many species could be found from inside, at the entrance, and outside of caves, indicating a wide range of host-seeking behavior or possible natural breeding in the karstic cave areas.Graphical abstract

Evaluation of the mpox surveillance system in Cameroon from 2018 to 2022: a laboratory cross-sectional study

BackgroundFormal assessment of a surveillance system’s features and its ability to achieve objectives is crucial for disease control and prevention. Since the implementation of the mpox surveillance system in Cameroon, no evaluation has been conducted.MethodsIn a cross-sectional study, we assessed the performance of the mpox surveillance system in accordance with the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines. We collected mpox surveillance data from 2018 to 2022 and conducted a survey with key stakeholders of the surveillance program. The survey results were summarized. The rates of complete reporting and mpox detection, as well as the time lag between the different stages of surveillance were analyzed using R version 4.1.ResultsThe mpox detection rate was 21.6% (29/134) over the five years under review. Surveillance indicators revealed that a combination of sample types, including vesicles, crust, and blood, was associated with higher case confirmation. Overall, the mpox surveillance system was effective. Weaknesses in terms of simplicity were identified. Most components of the assessed system failed to meet the timeliness and data quality goals, except for the laboratory component, which was commendable. The lack of a computerized shared database and the system’s non-sustainability were a course of concern.ConclusionsDespite all identified bottlenecks in the mpox surveillance system in Cameroon, it was found to meet it stipulated goals. Recommendations are made for training on surveillance system features, particularly at the facility/field level. Therefore, there is a crucial need to globally improve the mpox surveillance system in Cameroon for better disease control.

The Role of Professional Development and Technical Assistance in Supporting Implementation of COVID-19 Prevention Strategies in K-12 Schools.

Schools vary in their capacity to implement recommended strategies to prevent infectious diseases, such as COVID-19. Professional development (PD) and technical assistance (TA) are well-established tools used to strengthen school capacity and infrastructure for healthier school environments. The authors examined the relationship between PD and TA received by districts and schools and their implementation of COVID-19 prevention strategies during the 2020-2021 school year. We conducted a descriptive analysis of survey responses collected during Spring 2021 from selected districts and schools in 9 participating states. The survey assessed the implementation of 10 COVID-19 prevention strategies recommended by the Centers for Disease Control and Prevention and whether district or school staff received PD and/or TA on topics related to COVID-19 during the same year. Survey responses were received from designated contacts in 310 districts and 931 schools across 9 states. The dependent variable was the number of COVID-19 prevention strategies that were reported as "in place" by each district and school ranging from 0 to 10. On average, districts and schools reported implementing 7 of 10 recommended COVID-19 prevention strategies during the 2020-2021 school year. Schools that received PD on at least 1 of 12 topics reported implementing 7.61 COVID-19 prevention strategies, whereas schools that did not receive PD reported implementing 6.34 strategies. Similarly, schools that received TA on at least 1 topic reported higher COVID-19 implementation scores (7.51) than schools that did not receive any TA (7.20). Findings reveal a positive relationship between receiving PD and/or TA and implementation of COVID-19 prevention strategies in school settings.

Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods.

Monitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention's (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level "wastewater viral activity levels." In October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities. To produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results. COVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with "Very High" wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for "High" or "Low," obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality. Our methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.

Hospitalization and Health Resource Utilization in Emergency Department Cases of Diabetic Foot Infections in the U.S. from 2012 to 2021: A Nationally Representative Analysis

Objectives: The objective of this paper was to assess hospitalizations and health resource utilization associated with diabetic foot infection (DFI)-related visits within emergency departments (EDs) in the U.S. Methods: This nationally representative, cross-sectional historical cohort utilized the Centers for Disease Control and Prevention’s (CDC’s) National Hospital Ambulatory Medical Care Survey across a ten-year period from 2012 to 2021. Inclusion criteria were as follows: adults ≥18 years of age; a diagnosis of Type 1 or Type 2 diabetes mellitus; presence of a DFI. Comparisons were drawn relative to a cohort of patients with diabetes without foot complications. Study outcomes included 72-hour (72 h) ED revisit, hospitalization, and length of stay (LOS). Top diagnoses and medications were also reported. Multivariable, generalized, linear regression analyses were employed, controlling for key demographics, health system factors, clinical characteristics, and year. Results: An estimated 150.6 million ED visits included a diabetes diagnosis, with 2.4 million involving a DFI (1.6%). Approximately half of DFI cases were hospitalized (43.7%). Anti-infective medications were prescribed in 83.1% of DFI cases, including vancomycin in 28.1%. Multivariable analyses observed that DFIs were associated with a 3.002 times higher odds of hospital admissions (CI: 2.145–4.203, p &lt; 0.001) and a 55.0% longer LOS (IR = 1.550, CI: 1.241–1.936, p &lt; 0.001). DFIs were not significantly associated with a 72 h ED revisit. Conclusions: This nationally representative study of 2.4 million DFI-related ED visits in the U.S. observed higher odds of hospital admissions and a longer LOS for DFIs versus diabetes without foot complications. Continued research should seek to assess prevention and coordinated treatment interventions prior to the emergence of DFIs requiring ED care.

Pollutants-mediated viral hepatitis in different types: assessment of different algorithms and time series models

The escalating frequency of environmental pollution incidents has raised significant concerns regarding the potential health impacts of pollutant fluctuations. Consequently, a comprehensive study on the role of pollutants in the prevalence of viral hepatitis is indispensable for the advancement of innovative prevention strategies. Monthly incidence rates of viral hepatitis from 2005 to 2020 were sourced from the Chinese Center for Disease Control and Prevention Infectious Disease Surveillance Information System. Pollution data spanning 2014–2020 were obtained from the National Oceanic and Atmospheric Administration (NOAA), encompassing pollutants such as CO, NO2, and O3. Time series analysis models, including seasonal auto-regressive integrated moving average (SARIMA), Holt-Winters model, and Generalized Additive Model (GAM), were employed to explore prediction and synergistic effects related to viral hepatitis. Spearman correlation analysis was utilized to identify pollutants suitable for inclusion in these models. Concurrently, machine learning (ML) algorithms were leveraged to refine the prediction of environmental pollutant levels. Finally, a weighted quantile sum (WQS) regression framework was developed to evaluate the singular and combined impacts of pollutants on viral hepatitis cases across different demographics, age groups, and environmental strata. The incidence of viral hepatitis in Beijing exhibited a declining trend, primarily characterized by HBV and HCV types. In predicting hepatitis prevalence trends, the Holt-Winters additive seasonal model outperformed the SARIMA multiplicative model ((1,1,0) (2,1,0) [12]). In the prediction of environmental pollutants, the SVM model demonstrated superior performance over the GPR model, particularly with Polynomial and Besseldot kernel functions. The combined pollutant risk effect on viral hepatitis was quantified as βWQS (95% CI) = 0.066 (0.018, 0.114). Among different groups, PM2.5 emerged as the most sensitive risk factor, notably impacting patients with HCV and HEV, as well as individuals aged 35–64. CO predominantly affected HAV patients, showing a risk effect of βWQS (95% CI) = − 0.0355 (− 0.0695, − 0.0016). Lower levels of PM2.5 and PM10 were associated with heightened risk of viral hepatitis incidence with a lag of five months, whereas elevated levels of PM2.5 (100–120 μg/m3) and CO correlated with increased hepatitis incidence risk with a lag of six months. The Holt-Winters model outperformed the SARIMA model in predicting the incidence of viral hepatitis. Among machine learning algorithms, SVM and GPR models demonstrated superior performance for analyzing pollutant data. Patients infected with HAV and HEV were primarily influenced by PM10 and CO, whereas SO2 and PM2.5 significantly impacted others. Individuals aged 35–64 years appeared particularly susceptible to these pollutants. Mixed pollutant exposures were found to affect the development of viral hepatitis with a notable lag of 5–6 months. These findings underscore the importance of long-term monitoring of pollutants in relation to viral hepatitis incidence.

The impact of climate variation on the spread of Shiga toxin-producing E. coli.

Shiga toxin-producing Escherichia coli (STEC) is influenced by seasonality, but there is limited understanding of how specific climatic variables contribute to disease spread. This information aids in understanding disease transmission dynamics and could potentially inform public health modeling. This retrospective cohort study analyzed public health data from Ontario, Canada, between 2012 and 2021, along with historical climate data from Environment Canada. We employed Seasonal Autoregressive Integrated Moving Average (S-ARIMA) models to assess how temperature and precipitation impact the incidence of STEC infections, measured per 10,000,000 population. The study included 1658 confirmed STEC cases. A significant correlation was found between STEC incidence and climatic variables. Each degree Celsius increase in maximum temperature was associated with a rise of 3 STEC cases per 10,000,000 population (Centers for Disease Control and Prevention (2024)). Additionally, each millimeter of increased precipitation correlated with an increase of 1.1 cases per 10,000,000 population. The findings demonstrate a significant impact of temperature and precipitation on STEC transmission, highlighting the importance of integrating meteorological data into public health surveillance. This integration may help inform public health responses and support healthcare systems in planning for future outbreaks. Further studies are needed to refine predictive models and develop effective early warning systems for clinical settings.

Time interval distribution of hepatitis B vaccine immunization among infants in China from 2017 to 2021

ABSTRACT Infant hepatitis B vaccine coverage in China is high, with over 95% of infants immunized; however, high vaccine coverage can often mask low timeliness. The vaccination interval between the second and third doses is not clearly defined by immunization guidelines in China. This retrospective cohort study assessed the time interval distribution of hepatitis B vaccination among a cohort of randomly selected live births from the Centers for Disease Control and Prevention across four provinces or municipalities in China between January 2017 and December 2021. Among the infants analyzed, 163,224 received the first dose of hepatitis B vaccine with 146,905 (90.0%) and 135,757 (83.2%) infants receiving the second and third doses, respectively. A total of 132,577 (90.2%) infants received the second dose between 28 and 61 days after the first dose. Of the 119,437 (88.0%) infants that completed the hepatitis B series between 61 and 214 days after the second dose 87,067 (64.1%) infants were vaccinated with the third dose between 151 and 180 days after the second dose. The time interval distribution varied across the four provinces or municipalities (p < .001). Of the 58,077 infants who completed the hepatitis B vaccine series, 36,377 (62.6%) infants used the same type of hepatitis B vaccine for all three doses. Overall, the timeliness of hepatitis B vaccination for infants was lower than expected, with regional disparities observed. This highlights the need for improved timeliness through the introduction of a defined timeframe for the last two doses of vaccine and training for obstetricians and related personnel.

Assessment of Public Health Agency and Utility Training Needs for CDC National Wastewater Surveillance System Jurisdictions in the United States.

Since the start of the COVID-19 pandemic, wastewater surveillance hasemerged as a critical tool for tracking the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and other pathogens in communities throughout the United States. In 2020, the Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System (NWSS), which partners with state, local, tribal, and territorial health departments to develop and implement wastewater collection and analysis systems and to share data. In 2022, the CDC established the first two NWSS Centers of Excellence to lead its implementation and coordination efforts-one in Colorado (Colorado CoE) and one in Houston (Houston CoE). As the NWSS expands, it is becoming more important to support the training needs of jurisdictions at different stages of developing their wastewater surveillance infrastructure. To evaluate these needs, the Colorado CoE and Houston CoE conducted a needs assessment study of NWSS-funded public health agencies and public utilities departments located in the United States using surveys developed by the Colorado CoE. The results of the surveys showed that although some training needs were universal, it will be most beneficial to develop training modules tailored to the needs of entities that operate wastewater surveillance programs of various sizes, workforce experience levels, and at different stages in the infrastructure development process.

Experiences and Lessons Learned From Surging the Governmental Public Health Workforce During the COVID-19 Pandemic.

During the COVID-19 pandemic, the United States relied on the public health workforce to control the spread of COVID-19 while continuing to provide foundational public health services. Facing longstanding staffing shortages, state, tribal, local, and territorial (STLT) public health agencies (PHAs) used various strategies and supports to surge the workforce in response to the pandemic. The study explored (1) the types of strategies and supports STLT PHAs used to surge the public health workforce during the pandemic, (2) assessments of surge strategies and supports, and (3) approaches to using the range of surge strategies available. We conducted 27 semi-structured interviews in 2023 and performed thematic analysis. Interviewees included STLT public health officials, leaders of organizations that directly supported the COVID-19 workforce surge, and public health workforce experts indirectly involved in the workforce surge. To surge the workforce, interviewees relied on partnerships, staffing agencies, the National Guard, the Centers for Disease Control and Prevention Foundation's COVID-19 Corps, the Medical Reserve Corps, and other strategies. Interviewees valued strategies that rapidly engaged staff and volunteers at no cost to their PHA and flexible funding from the federal government to support surge efforts but noted shortcomings in the strategies and supports available. Interviewees described using multiple strategies simultaneously but noted challenges in implementing these strategies due to inadequate planning and insufficient staff and resources. The study underscores the need for STLT PHAs to establish mechanisms to surge the workforce as part of ongoing planning for emergency preparedness. Focus areas include building administrative and hiring capacity within STLT PHAs and sustaining partnerships and contractual agreements that helped fill staffing gaps during the pandemic. To support efforts to build workforce capacity to meet future surge management needs, STLT PHAs should consider creative solutions to attract and retain staff, as well as opportunities to engage students in public health work.

Microbiology testing capacity and antimicrobial drug resistance in surgical-site infections: a post-hoc, prospective, secondary analysis of the FALCON randomised trial in seven low-income and middle-income countries

Surgical-site infection (SSI) is one of the most common health-care-associated infections, substantially contributing to antibiotic use. Targeted antibiotic prophylaxis to prevent SSIs and effective treatment are crucial to controlling antimicrobial resistance (AMR). This study aimed to describe the testing capacity and multidrug resistance (MDR) of SSI microorganisms in low-income and middle-income countries (LMICs). This analysis included patients undergoing abdominal surgery in seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa) as part of the FALCON randomised controlled trial. Wound swabs were collected from patients diagnosed with SSI, as per US Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control definitions, were analysed alongside hospital-level data on local microbiological practices. An adjusted analysis was performed to identify perioperative factors associated with MDR. Testing capacity was assessed by the completion of swab testing in positively diagnosed SSIs. Between Dec 10, 2018, and Sept 7, 2020, 5788 patients were recruited to the FALCON trial. 1163 patients were diagnosed with an SSI, of whom 905 (77·8%) received prophylactic antibiotics before surgery. In patients with SSIs, 935 of 1163 (80·4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab performed (35 hospitals). Of 228 patients swabbed, 200 (88·5%) had microorganisms detected. Escherichia coli (89 of 200, 37·9%) was the most common microorganism and 116 of 200 (58·0%) patients were not covered by the perioperative prophylactic antibiotic. MDR was found in 102 of 147 (69·4%) patients for whom data were available to determine MDR status. Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0·43, 95% CI 0·19-0·96) and regular availability of infection control teams (0·32, 0·11-0·93) were associated with a significant reduction in MDR. Targeted perioperative antibiotic prophylaxis during contaminated abdominal surgery is insufficient in LMICs, with very few SSI organisms undergoing formal diagnosis. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams could support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR. National Institute for Health and Care Research. For the French and Spanish translations of the abstract see Supplementary Materials section.

HPV vaccination strategy for 14-year-old females and economic returns for cervical cancer prevention in Wuxi City, China: a cost effectiveness analysis

BackgroundSince December 2021, Wuxi, China has offered a two-dose human papillomavirus (HPV) vaccination to 14-year-old females for free. This study evaluated the costs and benefits of this vaccination scheduled in the Expanded Program on Immunization in Wuxi from the perspective of the cities’ demographic characteristics, economic development, and policy support.MethodsThe model-based economic evaluation used TreeAge Pro software to construct a decision tree-Markov model for the vaccination strategy in which 100,000 14-year-old females received two doses of bivalent HPV vaccine or no vaccination. Costs and effects of the strategy were assessed from a societal perspective through literature research and data obtained from the Wuxi Centre for Disease Control and Prevention. Univariate, multivariate, and probabilistic sensitivity analyses assessed the stability of the findings.ResultsThe cost of the bivalent HPV vaccine in Wuxi is 711.3 CNY. The two-dose of bivalent HPV vaccine for 100,000 14-year-old females would cost an additional 658,016 CNY compared to no vaccination, but would result in 1,960 Quality Adjustment Years of Life (QALYs). Using the per capita gross domestic product of 187,415 CNY in 2021 in Wuxi as the willingness-to-pay threshold, the vaccination strategy costs 3,357.37 CNY per QALY gained, which is much lower than the threshold, suggesting that it is a very cost-effective strategy. In addition, the vaccine strategy reduced the incidence of cervical cancer by 300 cases and cervical cancer deaths by 181 cases, representing a benefit-cost ratio of 2.86 (> 1) when health output outcomes were measured in monetary terms. These results suggested that the vaccination strategy was advantageous. Sensitivity analyses showed that changes in the parameters did not affect the conclusions and that the findings were robust.ConclusionsCompared to no vaccination, the delivery of two doses of bivalent HPV vaccine for 14-year-old females was a more highly cost-effective and optimal strategy.

Identifying Effective Strategies for Improving Engagement in HIV Prevention and Care Among Transgender Persons in the United States: A Systematic Review.

This systematic review synthesized published literature (2000 - 2023) to identify HIV interventions specifically designed for transgender persons in the United States (PROSPERO registration number: CRD42021256460). The review also summarized strategies for improving outcomes related to the four pillars of the Ending the HIV Epidemic (EHE) initiative in the United States: Diagnose, Treat, Prevent, and Respond. A comprehensive search was conducted using the Centers for Disease Control and Prevention's HIV Prevention Research Synthesis Project database, which included over 120,000 citations from routine systematic searches in CINAHL, EMBASE, Global Health, MEDLINE, PsycInfo, and Sociological Abstracts. Of 23 interventions that met inclusion criteria, 94% focused on transgender women of color and 22% focused on young transgender persons aged 15-29 years old. Most interventions focused on Treat or Prevent, few focused on Diagnosis, and none focused on Respond. Twenty interventions (87%) showed improvement in at least one EHE related outcome and a quarter of these effective interventions were tested with randomized controlled trials. Common strategies observed in effective interventions include the following: engaging the community in intervention development; pilot-testing with the focus population to ensure appropriateness and acceptability; addressing social determinants of health (e.g. stigma, discrimination, violence) through empowerment and gender-affirming approaches; increasing access to care, prevention, and services through co-location and one-stop shop models; and utilizing peer-led counseling, education, support, and navigation. Continuous effort is needed in addressing gaps, including more research for transgender men and rural settings and for how best to adopt and adapt best practices for subgroups of transgender population.