Centers For Disease Control Recommendations Research Articles

Addressing Barriers to Implementing and Scaling PrEP in Carceral Settings: Applying Insights From Implementation Science.

Within the United States, individuals experiencing incarceration are at higher risk for HIV acquisition than the general population, yet may face additional difficulty engaging in HIV prevention clinical services. HIV preexposure prophylaxis (PrEP) is an effective approach to preventing HIV transmission, and the Centers for Disease Control recommends that PrEP be offered in carceral settings, particularly during the vulnerable community reentry period. However, there have been few efforts to scale PrEP in this setting. Based on our experience implementing PrEP in Rhode Island's state carceral system, we have identified potential approaches to overcoming barriers to PrEP use in this unique practice environment by using the implementation research logic model. We then evaluated specific implementation determinants and barriers as well as strategies used to overcome those barriers to effectively scale PrEP in this setting. We developed a "toolkit," or 14-step guide, for others in the field to use for implementing PrEP in carceral settings, including the development and use of clinical protocols and community linkage strategies. Our experiences with barriers in the carceral setting, identifying and leveraging implementation strategies, allowed us to develop a "toolkit" to guide other PrEP implementation projects in carceral settings. We encourage others to scale-out our work to other carceral settings to better reach and engage a group of individuals both at elevated risk for HIV and currently underserved by HIV prevention strategies, including PrEP.

Prevalence of Overweight and Obesity of Preschool Children in Vranje (Serbia) According to the WHO and CDC Recommendations

Overweight and obesity are widespread worldwide among children of all age groups, and the prevalence among preschool children has been steadily increasing over the past twenty years. The aim of was to determine the prevalence of overweight and obesity of preschool children in Serbia based on the recommendations given by the WHO (World Health Organization) and the CDC (Centers for Disease Control and Prevention). The sample of respondents consisted of children from the preschool institution “Our Child” (serb. Naše dete) from Vranje, Serbia. A total of 380 children participated, of which 195 were boys (51.3%) and 185 were girls (48.7%). The age of the child ranged from 2 to 7 years, that is, from 26 to 84 months. In order to determine the weight status, the children’s body weight and height were measured, on the basis of which the Body Mass Index (BMI) was calculated. The obtained BMI values were interpreted based on the recommendations given by the WHO and the recommendations given by the CDC. Research results based on the WHO recommendations showed that 11.1% of the total number of children are overweight and 11.8% are obese, while based on the CDC recommendations, 11.8% of the total number of children are overweight and 7.9% are obese. Also, the research showed that there is no difference in the weight status categories between boys and girls. However, the results show that the proportions of overweight and obese children obtained using the WHO recommendations differ significantly from the proportions of overweight and obese children obtained using the CDC recommendations. High percentages of overweight and obesity among preschool children in Vranje require adequate measures to be taken in order to stop and reduce their growth.

Influence of Implementing an Opioid Stewardship Team in the Primary Care Setting.

Background: The Updated 2022 Centers for Disease Control (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain highlights the importance of shared decision making and provider-patient relationships. Interprofessional teams may be helpful in supporting providers and patients. A large, multi-site primary care department created an interprofessional primary care opioid stewardship team to target high-risk opioid prescribing and improve practice alignment with CDC recommendations through dashboard reporting and education. Objective: The primary objective was to assess reduction in morphine milligram equivalents (MME) from baseline to 6 months in patients on opioid doses ≥90 MME daily. The secondary objective assessed change in number of naloxone prescriptions from baseline to 6 months after education. Methods: The study was conducted across 30 primary care sites of one health system within Michigan from 2021 to 2022. The opioid stewardship team included 2 physicians, 3 pharmacists, a project operations manager, and IT support. Interventions included creation of a dashboard, provider education, dissemination of policy, and chart audits. Using the electronic health record (EHR) dashboard, patients on chronic opioid doses ≥90 MME daily or missing an active naloxone prescription were identified. Primary care providers (PCP) were provided with an individual list of patients for whom to consider intervention. Support was provided for prescribers, but the team did not interact with patients directly. Results: Baseline analysis identified 290 patients on doses ≥ 90 MME daily. There was reduction in median daily MME from baseline to 6 months in the overall study population (140 [105 240] vs 120 [90 240], P < .001). At 6 months 181 (62.4%) of patients had been given a prescription for naloxone versus 108 (37.2%) who had one at baseline, P < .001. Conclusion: The initiatives implemented by the opioid stewardship team resulted in statistically significant reductions in MME and an increase in naloxone prescribing from baseline to 6 months post-education.

Sexually Transmitted Infection/Human Immunodeficiency Virus, Pregnancy, and Mental Health-Related Services Provided During Visits With Sexual Assault and Abuse Diagnosis for US Medicaid Beneficiaries, 2019.

Centers for Disease Control recommends that the decision to provide sexually transmitted infection (STI)/human immunodeficiency virus (HIV) testing and presumptive treatment to patients who report sexual assault and abuse (SAA) be made on an individual basis. The 2019 Centers for Medicare & Medicaid Services national Medicaid data set was used. The SAA visits were identified by International Classification of Diseases 10th Revision Clinical Modification (O9A4 for pregnancy-related sexual abuse, T74.2 for confirmed sexual abuse, and Z04.4 for alleged rape). The initial SAA visit was defined as the patient's first SAA-related visit. Medical services were identified by International Classification of Diseases 10th Revision Clinical Modification codes, Current Procedural Terminology codes, and National Drug Code codes. Of 55,113 patients at their initial SAA visits, 86.2% were female; 63.4% aged ≥13 years; 59.2% visited emergency department (ED); all STI/HIV tests were provided in ≤20% of visits; presumptive gonorrhea and chlamydia treatment was provided in 9.7% and 3.4% of visits, respectively; pregnancy test was provided in 15.7% of visits and contraception services was provided in 9.4% of visits; and diagnosed anxiety was provided in 6.4% of visits. Patients who visited ED were less likely to have STI testing and anxiety than those visited non-ED facilities, but more likely to receive presumptive treatment for gonorrhea, testing for pregnancy, and contraceptive services. About 14.2% of patients had follow-up SAA visits within 60 days after the initial SAA visit. Of 7821 patients with the follow-up SAA visits within 60 days, most medical services provided were chlamydia testing (13.8%), gonorrhea testing (13.5%), syphilis testing (12.8%), HIV testing (14.0%); diagnosed anxiety (15.0%), and posttraumatic stress disorder (9.8%). Current medical services during SAA visits for Medicaid patients are described in this evaluation. More collaboration with staff who handle SAA will improve SAA-related medical services.

Stroke-associated pneumonia risk estimation in patients admitted to a comprehensive stroke unit at different phases after stroke

stroke is one of the leading causes of death and acquired disability among adults worldwide. Various complications frequently occur in patients with stroke and can significantly increase the risk for poor outcomes. Stroke-associated pneumonia, with the rate of up to 15%, is considered the most common serious medical complication in stroke patients. The aim of the study was to determine the independent predictors of the stroke-associated pneumonia in patients admitted to a comprehensive stroke unit at different time from stroke onset, as well as to develop a prognostic model for stroke-associated pneumonia risk estimation. Medical complications, including stroke-associated pneumonia, were documented in patients with clinical diagnosis of intraparenchymal cerebral stroke at admission and during their stay on the comprehensive stroke unit in 2010 to 2018. The workup at admission included assessment using the National Institutes of Health Stroke Scale and the modified Rankin scale. The diagnosis of stroke-associated pneumonia was made by specialists, in accordance with Centers for Disease Control recommendations. Qualitative variables are displayed as numbers and percentages, quantitative variables are displayed using the median (interquartile range). The method of logistic regression models was used to quantitatively assess the impact of characteristics on the PSP risk. The analysis was carried out using the package MedCalc v. 19.1. The study enrolled 539 patients, 309 (57.3%) men and 230 (42.7%) women. Median age of the patients was 66.0 years (57.9-75.1). Among the participants 101 (18.7%) were diagnosed with intracerebral hemorrhage, and 438 (81.3%) were diagnosed with ischemic stroke. Median initial National Institutes of Health Stroke Scale total score was 11 (6–18), median baseline modified Rankin scale score was 4 (3–5). Majority (64.1%) individuals were admitted within the first 30 days from onset, while 194 (35.9%) patients presented later. History of medical complications before the admission was present in 192 (35.6%) of the study participants, while during our in-hospital stay they occurred in 103 (19.1%) of the patients. The rate of new medical complications at the unit was significantly lower (p&lt;0.001) than prior to the admission. The diagnosis of stroke-associated pneumonia before the admission was established in 20 (3.7%), and during our in-patient treatment was made in 7 (1.3%) subjects (p&lt;0.001). Independent predictors of the stroke-associated pneumonia development were older age (odds ratio 1.11; 95% confidence interval 1.02-1.21, on average, for each additional year, p=0.02) and history of stroke-associated pneumonia at admission (odds ratio 12.2; 95 % confidence interval 2.0-72.4, p=0.006). Excellent sensitivity (85.7%), good specificity (75.0%) and area under the operating characteristic curve of 0.86 (95% confidence interval 0.83 – 0.89) for the developed prognostic model based on these of two variables, indicate their strong association with the risk of stroke-associated pneumonia during a comprehensive stroke unit stay. Therefore, stroke patients frequently develop medical complications at various stroke phases. The risk of stroke-associated pneumonia is higher in older patients and, especially, in those with stroke-associated pneumonia history. The lower rate of medical complications, in particular stroke-associated pneumonia, observed during in-hospital stay compared to the period prior to the admission may indicate the benefits of comprehensive stroke unit.

What Is the Impact of a Comprehensive Educational Program on Sterilization Processes in the Outpatient Physician Office Setting

<h3>Background</h3> Invasive procedures are routinely done in the outpatient physician office setting. Outpatient physician offices are often licensed for business occupancy and are not required to have accreditation, which limits health care regulatory requirements and mandated reporting. Furthermore, physician office staff often do not have the training or background education for proper instrument reprocessing. A potential risk of performing invasive procedures in the outpatient physician office setting include improperly sterilized or disinfected equipment and instruments, and the transmission of infectious pathogens to patients. The objective of this study was to improve sterilization processes and compliance with Center for Disease Control recommendations. <h3>Methods</h3> We conducted a pilot study at 13 outpatient physician offices that perform reprocessing of surgical instruments and equipment over the course of 1 year. A comprehensive tracer audit tool was developed to assess the level of compliance with Center for Disease Control (CDC) recommendations for sterilization and high-level disinfection in the outpatient physician office setting. A list of approved reprocessing supplies was created to standardize the process. Medical assistants and licensed vocational nurses who were responsible for performing sterilization received comprehensive education from a sterile processing educator. Their reprocessing skills were validated during a follow up visit that included a competency. <h3>Results</h3> Sterilization practices were improved as a result of this study and were demonstrated by competency validation and improved compliance scores on the trace audits at all 13 offices. <h3>Conclusions</h3> This study found that a comprehensive education program did improve compliance on sterilization processes in the outpatient physician offices which was demonstrated as by competency validation and increased compliance scores on the tracer audits at all offices. The improved sterilization processes have reduced the risk of infection and exposure to infectious pathogens in addition to reducing risk for the organization.

Why Is Right-Wing Media Consumption Associated With Lower Compliance With COVID-19 Measures?

Abstract. Exposure to right-wing media has been shown to be related to lower perceived threat from COVID-19, lower compliance with prophylactic measures against it, and higher incidence of infection and death. What features of right-wing media messages may account for these effects? In a preregistered cross-sectional study ( N = 554), we tested a model that differentiates perceived consequences of two CDC (Centers for Disease Control and Prevention) recommendations – washing hands and staying home – for basic human values. People who consumed more right-wing media perceived these behaviors as less beneficial for their personal security, for the well-being of close ones, and the well-being of society at large. Perceived consequences of following the CDC recommendations mediated the relationship between media consumption and compliance with recommendations. Implications for public health messaging are discussed.

Differential Adherence to Clinical Guidelines for Non-Viral Sexually Transmitted Infection Screening by Vaginitis Testing Type

The Centers for Disease Control (CDC) recommends that symptomatic women be tested for common causes of vaginitis using a laboratory-based test and also be co-screened for sexually transmitted infections. The two most common non-viral sexually transmitted infections (nvSTIs) in the United States are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), and CDC recommends testing for CT and NG using nucleic acid amplification tests (NAATs). The study objective was to (1) quantify the frequency of vaginitis testing and (2) assess the co-screening rate for CT and NG.

Liver Transplant in a Polymerase Chain Reaction–Positive COVID-19 Recipient: A Case Report

The severe acute respiratory syndrome coronavirus 2 coronavirus disease 2019 (COVID-19) global pandemic has ushered in an era of hesitation in performing transplants in affected patients. This stems from the paucity of data regarding the testing modalities, long-term implications, and uncertain prognosis in this group of patients. Current guidance from the Centers for Disease Control recommends assessing symptoms rather than polymerase chain reaction (PCR) positivity. In light of these recommendations, we describe a case of an orthotopic liver transplant in a patient infected with COVID-19 with persistent PCR positivity for 40 days before retransplant. The patient's perioperative and postoperative course was uncomplicated. Our experience leads us to advocate for liver transplants in patients who are PCR positive for COVID-19 after careful individualized and multidisciplinary evaluation regarding their liver disease and COVID-19 symptomatology.

Inhibitor Screening in Severe Hemophilia a: A Six-Year Single Center Experience

Background : Factor VIII (FVIII) inhibitors comprise the most morbid and expensive complication in severe hemophilia A. Inhibitor risk is known to be highest within the first 50 exposures to FVIII replacement products, with greatest risk during the first 20 exposures. Routine inhibitor screening is typically performed frequently with the first 20 to 50 exposures, but screening after 50 exposures is controversial, given the high cost of testing and unknown benefit. Early inhibitor detection allows effective treatment of bleeding with bypassing agents, and prompt initiation of immune tolerance to eradicate the inhibitor. Here we report inhibitor screening results at the University of Colorado Hemophilia and Thrombosis Center. Methods : This is a retrospective review of inhibitor testing data from study participants with severe hemophilia A enrolled, with Institutional Review Board approved informed consent, in the Hemophilia Prospective Inceptional Cohort Study (HEMO-PICS) from April 1, 2011 through April 1, 2017. A positive inhibitor was defined as modified Nijmegen Bethesda titer ≥0.5 confirmed on 2 separate blood draws. Tolerance was defined as a Bethesda titer <0.5 on two or more samples. The clinical protocol prescribed inhibitor screening in severe hemophilia A patients every 3-5 exposures prior to 50, and annually thereafter in accordance with National Hemophilia Foundation and US Centers for Disease Control recommendations. Results : Of 204 participants with severe hemophilia A in the study cohort, 24 had fewer than 50 factor exposures and were inhibitor negative at the start of the study observation period (“<50 Exposures Group”), 13 participants had a positive inhibitor at the start of the observation period (“+ Inhibitor Group”), and 167 had >50 exposures and a history of either no inhibitor or a tolerized inhibitor (“>50 Exposures Group”). Figure 1 shows inhibitor surveillance rates and results. In participants with < 50 exposures, positive inhibitors were detected in 11/42 screening tests, while participants with > 50 exposures had 0 positive inhibitors in 454 screening tests. In the “<50 Exposures Group”, 11 of 24 (45%) developed an inhibitor, 7 high titer (peak range 16.7 - 185 BU/mL) and 4 low titer (peak range 0.7 - 1.8 BU/mL). Six participants achieved 50 exposures without inhibitor development during the observation period, while the remaining 7 had fewer than 50 factor exposures at the end of the study period. The mean (+/- standard deviation) age of inhibitor development was 14.6 (+/- 6.2 [range 3-22]) months, after a mean of 12.8 (+/- 7.9 [range 1-29]) factor exposures. Six of those who developed inhibitors did so prior to starting prophylaxis, and the other 5 patients developed inhibitors within 2 months of prophylaxis initiation. Of those who did not develop inhibitors, 8 have been on prophylaxis for an average of 36 (+/- 23.8 [range 14-80]) months, 3 are planning to start prophylaxis, and 2 have declined. Of the 13 participants in the “+ Inhibitor Group”, 3 were tolerized during the study. Conclusion : We report a high rate of positive inhibitor surveillance tests in severe hemophilia A patients during the first 50 exposures (1 per 3.8 tests), and very low rates of positive inhibitors in this population following 50 exposures (0/454). While our results reinforce the practice of frequent inhibitor screening in patients with < 50 factor exposures, screening for inhibitors in patients with > 50 exposure days and no change in the bleeding phenotype is unlikely to be clinically relevant and should not be routinely performed. [Display omitted] DisclosuresWarren:CSL Behring Heimburger Award: Research Funding; Bayer Hemophilia Awards Program: Research Funding. Ng:CSL Behring Heimburger Award: Research Funding; Shire: Consultancy. Buckner:Shire: Membership on an entity's Board of Directors or advisory committees; Uniqure: Consultancy; Genentech: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees.

Emerging Adults' Adherence to Preventative Health Guidelines in Response to COVID-19.

ObjectiveTo examine rates of emerging adults’ (EA) adherence to preventative health behavior recommendations during early months of the COVID-19 pandemic and to investigate demographic (i.e., gender, years of education, socioeconomic status, school enrollment status, and living situation) and exposure and impact-related correlates of adherence.MethodsParticipants were 273 [M (SD) age = 22 (2.1) years, 55% female, 32% from minoritized groups] EA completed an online survey of adherence to 11 preventative health behaviors recommended by the Centers for Disease Control (CDC) during summer 2020. Participants rated adherence via a visual analog scale. Participants also reported demographic information and completed the COVID-19 Exposure and Family Impact Adolescent and Young Adult Version (CEFIS-AYA).ResultsMedian levels of adherence to preventative recommendations ranged from 66% to 100%. Highest adherence levels (Mdn > 90%) were reported for quarantining if exposed to COVID-19; covering mouth when sneezing; avoiding the elderly/those at high risk; and avoiding large gatherings. Median adherence was <80% for mask wearing; maintaining a 6-foot distance; avoiding in-person visits with romantic partners or friends; and disinfecting surfaces. Female gender was the only variable significantly associated with overall adherence, and it explained 4% of the variance.ConclusionsFollowing guidelines related to social distancing practices may be particularly challenging for EA, possibly because of unique developmental needs of this group, and males may be at greater risk for non-adherence to CDC recommendations. Therefore, public health messaging and adherence intervention development should be designed with males and social distancing practices in mind.

Black American Men and Complex Societal Educational Navigation of the Emergency Public Health Pandemic of COVID 19

COVID-19, also known as Coronavirus, is an emergency pandemic that has an impact worldwide. In the U.S., a disturbing trend is where African Americans are experiencing a disproportionate amount of death. The US Centers for Disease Control recommends facemasks as protection from COVID-19. Many Black men feel that wearing a mask will give them the perception of being a criminal or being threatening in a non-Black community. Many Black men feel that wearing these masks will lead to racial profiling from people and police. Many Black men have a sense of anxiety about wearing a mask because they fear that it draws unwanted attention by wearing a mask in public. This paper explores this complexity through a content analysis of current events and theoretical literature. This applied research project intends to shed light on unique challenges facing people of Black American men as they attempt to navigate COVID-19.

Relationship between hepatitis C virus (HCV) IgG index values and quantitative HCV RNA results in HCV IgG-reactive serum samples

Centers for Disease Control guidelines recommend hepatitis C virus (HCV) RNA testing of all HCV IgG-reactive samples, although earlier studies found that IgG-reactive samples with low indices were negative in qualitative RNA assays. To determine if previous study results could be confirmed using current real-time RT-PCR technology, we investigated the relationship between HCV IgG index (Ortho VITROS) and quantitative HCV RNA results (cobas HCV) for 2368 consecutive IgG-reactive sera. Results were segregated into Low (1.00–16.0), Medium (16.1–30.0), and High (>30.0) IgG index groups. Although median viral load (VL) of RNA-positive samples was similar in all 3 groups, the percentage with low VL (1.18–4.16 log IU/mL) was increased for the Low group. Further analysis of the Low group revealed that 23 of 370 (6%) samples with IgG indices ≤8.00 were RNA-positive, and 13/23 (57%) had low VL. Our analysis supports the Centers for Disease Control recommendation to test all HCV IgG-reactive sera for HCV RNA.

Thematic Analysis of Parent-Child Conversations About COVID-19: "Playing It Safe".

Caregivers have primary responsibility for teaching their children self-protective behaviors, including those behaviors recommended by the Center for Disease Control (CDC) to prevent the spread of COVID-19. Parents have an important role in scaffolding adherence to the CDC recommendations and in managing stress and regulate their emotions to adaptively cope during uncertain times like those facing communities nationwide. The present study is a qualitative, thematic analysis of parent-reported (n = 210; 64.8% female; average age = 39.33; 14.3% ethnic/racial minority) interactions with children (focal child age: 25.2% birth to 5 years old, 36.7% 6 to 11 years old, 37.6% 12 to 18 years old) about topics associated to COVID-19-related viral transmission suppression guidelines and stress/coping behaviors. Themes included discussions about personal and social hygiene, and parent reported sources of child stress, and child stress management efforts. Findings from our thematic analysis indicate parents are motivated to make scaffolding personal hygiene fun and engaging, signaling a positive, developmentally appropriate native approach to their role as sources of coping socialization. These findings also underscore the importance of providing information to parents in ways that can be translated to children in developmentally appropriate conversations about viral transmission suppression activities and stress management during disasters.

Supporting Medical Providers to Combat Vaccine Hesitancy.

Supporting Medical Providers to Combat Vaccine Hesitancy Magdi Awad, PharmD, MSA, Kenneth Furdich, PharmD, BCACP, Dana Webb, PharmD, and E. Demond Scott, MD, MPH To the Editor: COVID-19 vaccine hesitancy during the SARS-CoV-2 public health crisis has the potential to significantly increase disease burden throughout the world.1 Vaccinations currently available have an increasing amount of data to support both their safety and efficacy at preventing disease.2,3 However, serious efforts, both educational and logistical, must take place to maximize the public's vaccination uptake.4 Polls assessing vaccine hesitancy in the general population have shown hesitancy persisting despite vaccination campaigns being underway. National polling data as of February 2021 has demonstrated up to 44% of the general population is still displaying vaccine hesitancy. Specifically, 22% report they would want to wait and see how the vaccine is working before getting it, 7% would get the vaccine if required by school or work, and 15% would definitely not get the vaccine.5 Despite Centers for Disease Control recommendations, health care workers are also displaying vaccine hesitancy. A study conducted in a large university health care system observed attitudes towards COVID-19 vaccination among health care personnel. The various personnel being surveyed ranged from physicians to non-clinical ancillary staff. Results from this survey showed 58% of respondents said they would get vaccinated, 26% were unsure, and 16% reported they would not get vaccinated. Additionally, 20% of physicians and 45% of master's-level clinicians reported they were not sure or strongly disagreed to getting a COVID-19 vaccine if one were offered to them for free.6 Among the most significant contributors to vaccine hesitancy is the misinformation projected on social media. Misinformation being spread to the public include assertions the vaccine trials were rushed, the vaccine technology is new, or that the vaccine alters one's genetic makeup.7 While this information is false, clinicians must be ready to provide demonstrated facts and recommendations to combat the spread of misinformation. Health care providers have not only an opportunity, but an obligation, to dispel the myths about COVID-19 and its vaccines. They must anticipate, validate, and be prepared to address patients' questions and concerns about the vaccine. To do so, health professionals must be able to demonstrate their own confidence in the benefits of the vaccine being greater than any possible difficulties.8 Moreover, health care providers' ability to combat vaccine myths is especially important in underserved and minority [End Page xiv] communities. Patients tend to accept preventative medicine recommendations from providers with the same ethnicity and race as themselves, and providers of color are disproportionately likely to practice in communities of color.9 Educational interventions for providers may be helpful to increase confidence in deflating vaccination myths and help them to promote vaccination in their patients. As an example, a small community health center with multiple locations serving underserved communities in Ohio used its pharmacy-led academic detailing approach to educate the medical and pharmacy providers about the COVID-19 vaccines.10 Before and during the educational presentation, questions were sought from the providers and free engagement was promoted to share insights. The academic detailing session also covered common misinformation as well as factual information refuting common erroneous claims. A survey of the medical providers was then circulated to assess comfort in recommending the COVID-19 vaccination to patients (item #1), addressing vaccine hesitancy (item #2), and addressing use of the vaccine in special populations (e.g., immune-deficient, previous COVID-19 exposure) (item #3). Results from the survey (n=12, 75% response rate) were analyzed using Cohen's D to evaluate effect size.11 The analysis revealed the academic detailing session had a medium positive effect on item #1, a large positive effect on item #2, and a very large positive effect on item #3. Education and the dissemination of factual data are pathways to reduce vaccine hesitancy. This education empowers providers to educate their patients regarding COVID-19 vaccines and dispel misinformation which could lead to greater public harm. Educational interventions as described above should be considered by clinics and health centers to aid in combatting the SARS-CoV-2 pandemic. References...

9. Influenza Vaccine Rates Amongst Patients With Limited English Proficiency In A Primary Health Care Clinic; Our 3 Years Experience

BackgroundInfluenza has been recognized to be a significant cause of morbidity and mortality. It was the cause of 10.1% of all deaths recorded on death certificates during the week ending January 20, 2018.In order to reduce the risk of influenza, Centers for Disease Control recommends that every person six months and older who have no contraindications be vaccinated with the influenza vaccine.Limited English Proficiency (LEP) describes individuals who have limited ability to speak, read, write or understand English language. Sadly, there is an increasing body of data that suggest that patients with LEP are less likely to seek out medical attention in a timely manner, are less adherent to medically recommended preventive and therapeutic measures. The purpose of this study was to determine the rate of acceptance of the Influenza vaccine amongst patients with LEP in our resident ran out-patient clinic.MethodsThis study was retrospective, data was obtained through chart review of the electronical medical records (EMR). Patients had to be at least 18 years old and registered patients at our primary health care clinic to be enrolled in this study. Data was gathered for the 2015–2016, 2016–2017 and 2017–2018 influenza seasons. The months of October to May were designated as the Influenza season as these months have been identified as the time frame that the influenza virus has the most activity.Results109 of 499 the randomly selected participants were not included in the final analysis due to reasons like: no visit to the primary health care clinic during specified periods, ability to communicate in English, insufficient data in to the EMR. Data from 390 patients were analyzed. 43.3% spoke Spanish, 36.2% were Portuguese speaking and 20.5% spoke other languages. A large majority of patients across all language groups did not receive the influenza vaccine each season.Table 1 Figure 1 Figure 2 ConclusionResults from this study indicate that there was an alarmingly low rate of influenza vaccination among patients with LEP in our primary care clinic in during the 2015–2016, 2016–2017 and 2017–2018 influenza seasons. This highlights the need for implementing interventions aimed at both understanding why this vaccination gap exist and improving the vaccine acceptance rate amongst this venerable population.Disclosures All Authors: No reported disclosures

The Impact of COVID-19 Safety Recommendations on Adults Age 60 and Older: A Qualitative Study

In March 2020, the United States Centers for Disease Control (CDC) began recommending social distancing and sheltering in place, in particular for older adults. This resulted in many older adults staying at home for long periods of time in relative isolation. Because there is little prior evidence of the emotional impact that this has on older adults, we conducted an exploratory qualitative study on how older adults felt during the first three to five weeks of the CDC recommendations. We fielded a web-based cross-sectional survey. Our analytic sample consisted of 673 respondents aged 60 and older who respondent to the prompt: “How are you feeling during this time of social distancing?”. We used a thematic bottom-up qualitative analysis, via MAXQDA, to analyze segments into general affect codes and detailed emotion subcodes, as well as coping mechanisms. Results showed that while many older adults reported neutral (9%) or positive (9%) affect, a larger proportion reported negative affect (42%) or reported mixed affect (35%). The most common negative emotions mentioned were anxiety and loneliness/boredom, while the most common positive emotions mentioned were optimism and feeling grateful. The most common coping mechanisms reported by participants included making life adjustments, keeping busy, prayer/spirituality, and mediation/mindfulness. This study provides an initial understanding into how older adults experienced and coped with the first stages of restricting social interactions. If social distancing continues to be a recommended disease-containment strategy, information about how older adults are coping can be critical for public health interventions. Implications will be discussed.

Assessing how face masks affect speech intelligibility

To limit transmission of Covid-19, the Centers for Disease Control recommends covering the mouth and nose with a mask while interacting in public. Although face masks protect public health by containing respiratory aerosols and droplets, they can hinder speech perception by filtering the acoustic signal. Here, we assess how masks affect speech intelligibility in audio-only conditions. Four young adult native speakers of American English, naïve to the purpose of the experiment, produced short low-probability sentences in four conditions: dual-layer cloth, disposable surgical, N95, and no mask. Multitalker babble was applied to the stimuli. Listeners recruited through Amazon Mechanical Turk rated the intelligibility of the sentences, with speaker and mask condition counterbalanced. Along with obtaining overall intelligibility ratings as a percentage of words recognized, we will also compute intelligibility for consonants that are known to be differentiated by high-frequency spectral cues, and assess the long-term average spectra for the different mask types. We hope that the information from this study will help us understand the impact of masks on speech perception. Going forward, we will carry out parallel experiments with older individuals and those with hearing loss.

Building the National SARS-CoV-2 Laboratory Diagnostic Capacity in Taiwan.

Through early and proactive laboratory testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes novel coronavirus 2019, Taiwan has demonstrated an efficient and rapid control response to contain the outbreak. Two days after the World Health Organization announced the complete viral genome sequence, the national laboratory of the Taiwan Centers for Disease Control developed a specific real-time reverse transcription polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2. The national laboratory network was further strengthened through the recruitment of medical centers and regional hospitals distributed throughout most geographical regions of the country. Ultimately, a network of 60 laboratories with a capacity of 7,342 real-time RT-PCR tests per day was established. Between January 14 and August 5, 2020, a total of 158,772 tests were conducted, corresponding to 120,487 cases. Test results were obtained within 24 hours, enabling an efficient and rapid control response.

Managing Food Allergy in Schools During the COVID-19 Pandemic

In the wake of the COVID-19 pandemic and massive disruptions to daily life in the spring of 2020, in May 2020, the Centers for Disease Control (CDC) released guidance recommendations for schools regarding how to have students attend while adhering to principles of how to reduce the risk of contracting SARS-CoV-2. As part of physical distancing measures, the CDC is recommending that schools who traditionally have had students eat in a cafeteria or common large space instead have children eat their lunch or other meals in the classroom at already physically distanced desks. This has sparked concern for the safety of food-allergic children attending school, and some question of how the new CDC recommendations can coexist with recommendations in the 2013 CDC Voluntary Guidelines on Managing Food Allergy in Schools as well as accommodations that students may be afforded through disability law that may have previously prohibited eating in the classroom. This expert consensus explores the issues related to evidence-based management of food allergy at school, the issues of managing the health of children attending school that are acutely posed by the constraints of an infectious pandemic, and how to harmonize these needs so that all children can attend school with minimal risk from both an infectious and allergic standpoint.