Massachusetts Department Of Public Health Research Articles

Anomalous Antimicrobial Susceptibility Trend Identification.

Antibiotic resistant bacterial infections are a growing global health crisis. Antibiograms, aggregate antimicrobial resistance reports, are critical for tracking antibiotic susceptibility and prescribing antibiotics. This research leverages fifteen years of the expansive Massachusetts statewide antibiogram dataset curated by the Massachusetts Department of Public Health. Given the lengthy annual antibiogram creation process, data are not timely. Our prior research involved forecasting the current antimicrobial susceptibility given historic antibiograms. The objective for this research is to expand upon this prior work by identifying which antibiotic-bacteria combinations have resistance trends that are not well forecasted. For that, our proposed Previous Year Anomalous Trend Identification (PYATI) strategy employs a cluster driven outlier detection solution to identify the trends to remove before forecasting. Employing PYATI to remove antibiotic-bacteria combinations with anomalous trends statistically significantly reduces the forecasting error for the remaining combinations. As antibiotic resistance is furthered by prescribing ineffective antibiotics, PYATI can be leveraged to improve antibiotic prescribing.

Characteristics of Adults With Congenital Heart Defects in the United States

BackgroundIn the United States, >1 million adults are living with congenital heart defects (CHDs), but gaps exist in understanding the health care needs of this growing population. ObjectivesThis study assessed the demographics, comorbidities, and health care use of adults ages 20 to 64 years with CHDs. MethodsAdults with International Classification of Disease-9th Revision-Clinical Modification CHD-coded health care encounters between January 1, 2008 (January 1, 2009 for Massachusetts) and December 31, 2010 were identified from multiple data sources at 3 U.S. sites: Emory University (EU) in Atlanta, Georgia (5 counties), Massachusetts Department of Public Health (statewide), and New York State Department of Health (11 counties). Demographics, insurance type, comorbidities, and encounter data were collected. CHDs were categorized as severe or not severe, excluding cases with isolated atrial septal defect and/or patent foramen ovale. ResultsCHD severity and comorbidities varied across sites, with up to 20% of adults having severe CHD and >50% having ≥1 additional cardiovascular comorbidity. Most adults had ≥1 outpatient encounters (80% EU, 90% Massachusetts, and 53% New York). Insurance type differed across sites, with Massachusetts having a large proportion of Medicaid (75%) and EU and New York having large proportions of private insurance (44% EU, 67% New York). Estimated proportions of adults with CHD-coded health care encounters varied greatly by location, with 1.2 (EU), 10 (Massachusetts), and 0.6 (New York) per 1,000 adults based on 2010 census data. ConclusionsThis was the first surveillance effort of adults with CHD-coded inpatient and outpatient health care encounters in 3 U.S. geographic locations using both administrative and clinical data sources. This information will provide a clearer understanding of health care use in this growing population.

Changes in Interventional Radiology Practice in a Tertiary Academic Center in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic.

The first clinical case of coronavirus disease 2019 (COVID-19) was reported in Wuhan in China in December 2019 [1]. Since then, there have been more than 1,171,000 confirmed cases and 68,000 deaths in the United States as of May 5, 2020 [2]. To mitigate the spread of the disease, the Governor of the Commonwealth of Massachusetts issued a “social distancing” order on March 23, 2020 [3], and the Massachusetts Department of Public Health issued a “stay-at-home” advisory on March 24, 2020 [4]. In this context, hospital networks implemented significant changes in practice and workflow, particularly among procedure-based specialties, to facilitate the anticipated surge in COVID-19-related hospital admissions.

Perceptions of implementation of Massachusetts sports concussion regulations: results of a survey of athletic directors

BackgroundIn 2011 the Massachusetts Department of Public Health issued regulations pursuant to 2010 Massachusetts youth sports concussion legislation that provided policies and procedures for persons engaged in the prevention, training, management, and return-to-activity for students who sustain head injury during interscholastic athletics, including Athletic Directors (ADs).MethodsA survey instrument was developed with participation from injury prevention experts at the Boston University School of Medicine, the Massachusetts Department of Public Health, and ADs. An electronic survey was sent to all AD members of the Massachusetts Interscholastic Athletic Association to assess their perceptions of implementation of the sports concussion law.ResultsResponse rate was 75% (260/346). The mean rating on a 0–10 scale (10 being “very important”) on importance of the law for student safety was 9.24, and the mean rating of the law’s impact on workload was 5.54. Perceived impact on workload varied as a function of whether or not the school also employed an athletic trainer (t = 2.24, p = 0.03). Most respondents (88%) reported that their school had a concussion management team, and 74% reported that they were informed “always” (31%) or “often” (43%) when a student-athlete experienced a head injury in a venue other than extracurricular sports. Most respondents (95%) endorsed that “all” or “most” school nurses were “very knowledgeable” about the law and regulations. Approximately half of all respondents endorsed that “all” or “most” teachers and guidance counselors were “very knowledgeable” about the law and regulations; 76% endorsed that “all” or “most” of students’ physicians were “very knowledgeable” about the law and regulations; 59% endorsed that “all” or “most” parents were “very knowledgeable” about the law and regulations. Sixty-six percent endorsed that student-athletes with concussion “often” (10%) or “sometimes” (56%) misrepresent their symptoms to accelerate return-to-play; and, 70% perceived that student-athletes with concussion “often” (15%) or “sometimes” (55%) misrepresent their symptoms to avoid academics.ConclusionsADs perceive the sports concussion legislation as very important to student safety and positively assess implementation of the law and associated regulations. More effort is needed to increase understanding of the law among stakeholders including teachers, parents, and physicians.

Evaluation of Implementation of Massachusetts Sports Concussion Regulations: Results of Focus Groups with Athletic Directors

In 2018, the Massachusetts Department of Public Health (MDPH) conducted focus groups with athletic directors (ADs) from Massachusetts middle and high schools to assess the implementation of legislated regulations relative to the management of concussion (mild traumatic brain injuries; mTBI) among students engaged in extracurricular sports. Two tape-recorded focus groups were conducted with a facilitator. Lists of themes were synthesized by investigators. Overall, participating ADs expressed that the law and accompanying regulations were necessary and important for protecting student athletes, despite some burdensome aspects of implementation. Emerging themes included support for the law, some implementation problems, impact on workload, and recommendations for improving mandated procedures. ADs assume an important role in the management of middle and high school students’ mTBI when given the authority to do so through legislation and regulation. Nonetheless, challenges to the daily application of legislated protocols exist and should continue to be evaluated.

Provision of STD Services in Community Settings After the Loss and Return of State Funding to Support Service Provision: Observations From Select Providers in Massachusetts, 2010 and 2013.

In 2008, the $1.2 M sexually transmitted disease (STD) services line item supporting STD clinical services by the Massachusetts Department of Public Health was eliminated, forcing the cessation of all state-supported STD service delivery. To determine the impact on community provision of STD services after the elimination of state funds supporting STD service provision. Rapid ethnographic assessments were conducted in May 2010 and September 2013 to better understand the impact of budget cuts on STD services in Massachusetts. The rapid ethnographic assessment teams identified key informants through Massachusetts's STD and human immunodeficiency virus programs. Fifty providers/clinic administrators in 19 sites (15 unique) participated in a semistructured interview (community health centers [n = 10; 53%], hospitals [n = 4; 21%], and other clinical settings [n = 5; 26%]). Results clustered under 3 themes: financial stability of agencies/clinics, the role insurance played in the provision of STD care, and perceived clinic capacity to offer appropriate STD services. Clinics faced hard choices about whether to provide care to patients or refer elsewhere patients who were unable or unwilling to use insurance. Clinics that decided to see patients regardless of ability to pay often found themselves absorbing costs that were then passed along to their parent agency; the difficulty and financial strain incurred by a clinic's parent agency by providing STD services without support by state grant dollars emerged as a primary concern. Meeting patient demand with staff with appropriate training and expertise remained a concern. Provision of public health by private health care providers may increase concern among some community provision sites about the sustainability of service provision absent external funds, either from the state or from the third-party billing. Resource constraints may be felt across clinic operations. Provision of public health in the for-profit health system involves close consideration of resources, including those: leveraged, used to provide uncompensated care, or available for collection through third-party billing.

Access to naloxone at community pharmacies under the Massachusetts statewide standing order

ObjectiveThis study aimed to evaluate access to, and barriers to accessing, naloxone at community pharmacies throughout Massachusetts following implementation of new legislation that requires all community pharmacies to maintain a sufficient supply for dispensing under a statewide standing order. DesignFrom September 2018 through January 2019, we conducted a cross-sectional telephone-based survey of Massachusetts pharmacies by having an interviewer pose as a customer seeking naloxone. Setting and participantsCommunity pharmacies were identified from a list of all actively licensed pharmacies provided by the Massachusetts Department of Public Health and one-half were randomly selected for inclusion. Pharmacies that were permanently closed, duplicated on the list, or closed to the general public were excluded from analysis. Outcome measuresRates of stocked naloxone, perceived need for identification or prescription, and pricing. ResultsOf the 524 pharmacies surveyed, 97.7% (n = 512) reported routinely stocking naloxone. Of those, 90.4% (n = 463) had naloxone in stock on the day of contact. Most pharmacies with naloxone in stock did not require a prescription (96.1%; n = 445); at these pharmacies, personal identification was required by 38.9% (n = 180). The average out-of-pocket naloxone nasal spray price was $128.34 ± $40.75. ConclusionNearly all Massachusetts community pharmacies routinely stock naloxone as required by state law; however, barriers remain regarding perceived need for identification and high out-of-pocket costs.

Assessing Pregnancy, Gestational Complications, and Co-morbidities in Women With Congenital Heart Defects (Data from ICD-9-CM Codes in 3 US Surveillance Sites)

Improved treatment of congenital heart defects (CHDs) has resulted in women with CHDs living to childbearing age. However, no US population-based systems exist to estimate pregnancy frequency or complications among women with CHDs. Cases were identified in multiple data sources from 3 surveillance sites: Emory University (EU) whose catchment area included 5 metropolitan Atlanta counties; Massachusetts Department of Public Health (MA) whose catchment area was statewide; and New York State Department of Health (NY) whose catchment area included 11 counties. Cases were categorized into one of 5 mutually exclusive CHD severity groups collapsed to severe versus not severe; specific ICD-9-CM codes were used to capture pregnancy, gestational complications, and nongestational co-morbidities in women, age 11 to 50 years, with a CHD-related ICD-9-CM code. Pregnancy, CHD severity, demographics, gestational complications, co-morbidities, and insurance status were evaluated. ICD-9-CM codes identified 26,655 women with CHDs, of whom 5,672 (21.3%, range: 12.8% in NY to 22.5% in MA) had codes indicating a pregnancy. Over 3 years, age-adjusted proportion pregnancy rates among women with severe CHDs ranged from 10.0% to 24.6%, and 14.2% to 21.7% for women with nonsevere CHDs. Pregnant women with CHDs of any severity, compared with nonpregnant women with CHDs, reported more noncardiovascular co-morbidities. Insurance type varied by site and pregnancy status. These US population-based, multisite estimates of pregnancy among women with CHD indicate a substantial number of women with CHDs may be experiencing pregnancy and complications. In conclusion, given the growing adult population with CHDs, reproductive health of women with CHD is an important public health issue.

Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth

To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6days after birth. Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016. Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period. Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6days after birth in the US and Massachusetts.

Using HIV Surveillance and Clinic Data to Optimize Data to Care Efforts in Community Health Centers in Massachusetts: The Massachusetts Partnerships for Care Project.

We describe Data to Care processes of the Massachusetts Partnerships for Care (MA P4C) project and identify factors associated with engagement, retention, and viral suppression outcomes. The Massachusetts Department of Public Health and participating community health centers generated lists of patients not in care based on a temporal gap in laboratory results, missed clinic visits, and provider concern regarding engagement. The Massachusetts Department of Public Health and community health centers reviewed the lists monthly and identified out-of-care patients in need of linkage or re-engagement. Between October 2015 and June 2017, of 1418 patients potentially out of care, 83 (5.9%) were confirmed to be out of care. Forty-four of those out of care (53%) received services or were re-engaged in care within 90 days, 45 (54%) were retained in care, and 40 (48%) were virally suppressed. The odds of being re-engaged or retained were lower for patients who were 6 months out-of-care (vs. those newly diagnosed). Patients with an AIDS-defining condition had increased odds of retention and viral suppression. The odds of viral suppression were reduced for patients who reported exposure categories other than men who have sex with men and were younger (30-49 years vs. ≥50 years). Although rates of re-engagement, retention, and viral suppression were low, the MA P4C Data to Care procedures provided a means for accurate ascertainment of out-of-care status. Future Data to Care programs should investigate the factors that contribute to disengagement from care.

The Partnerships for Care Project in Massachusetts: Developing Partnerships and Data Systems to Increase Linkage and Engagement in Care for Individuals Living With HIV.

Before implementation of the Massachusetts Partnerships for Care (MA P4C) project, Massachusetts did not routinely provide HIV partner services to newly diagnosed individuals. Identification of individuals disengaged from HIV care and assistance for re-engagement relied on community- and clinic-based HIV medical case management services. Processes to identify individuals out of HIV care used either surveillance or clinic data, but did not combine both. The Massachusetts Department of Public Health collaborated with 6 community health centers to implement HIV partner services and out-of-care re-engagement services. Implementation of these services required development of both health department and community health center capacity. Capacity development strategies included the following: development and implementation of operational protocols, establishment of communication strategies and processes, training and education for health department and health center staff, and enhancement of disease surveillance systems. Development of operational protocols supported implementation of public health services and collaboration with health centers. Health department-facilitated meetings, training, and technical assistance enhanced communication with health centers and promoted buy-in for collaboration. A strategy for combining clinic and surveillance data to identify individuals out of HIV care was implemented. Surveillance data system enhancements improved efficiency of out-of-care identification, assignment of cases for public health follow-up, and provided quality improvement tools. Collaboration between health departments and community health centers to identify and support patient engagement in HIV medical care is feasible and supports improved continuity of care. Use of surveillance and clinic data to identify out-of-care patients promotes efficiency in Data to Care activities.

Factors associated with help seeking by community responders trained in overdose prevention and naloxone administration in Massachusetts

BackgroundCommunity overdose responders do not always seek help from emergency services when administering naloxone. We aimed to identify responder, overdose event, and community characteristics associated with help seeking from emergency services during overdoses reported by Massachusetts Overdose Education and Naloxone Distribution (OEND) enrollees, and to assess trends in help seeking over time. MethodsWe analyzed overdose reports submitted between 2007 and 2017 to the Massachusetts Department of Public Health. We used logistic regression, stratified by responder drug use status, to assess associations of characteristics with help seeking during an overdose. ResultsFrom January 2007 through December 2017, there were 69,870 OEND enrollees. 5,588 enrollees reported 10,246 overdoses. Help seeking was more likely among responders who did not use drugs. Among responders who did not use drugs, help seeking was more likely when: the responder was older or female, the victim was a stranger or client, and when naloxone did not work. Among responders who used drugs, help seeking was more likely when: the responder was female or had not previously reported responding to an overdose, the victim was a stranger or client or did not use fentanyl, naloxone took a longer time to work, and when the overdose was public or occurred more recently. The percentage of overdoses where help seeking occurred reached a maximum in 2016 at 50%. ConclusionsHelp seeking by OEND enrollees was significantly associated with several responder, victim, and event characteristics. Targeted interventions to promote help seeking are warranted, particularly as the lethality of opioid supplies rises.

Syndrome Development to Assess IDU, HIV, and Homelessness in MA Emergency Departments

Syndrome Development to Assess IDU, HIV, and Homelessness in MA Emergency Departments

Community health contexts and school suspensions of students with disabilities

PurposeStudents with disabilities with unmet health care needs are vulnerable to adverse educational outcomes, including exclusionary discipline. We examined the association between schools' spatial proximity to health care providers and their use of suspension to discipline students with disabilities. MethodsThe study sample included the 398 public secondary schools in the Boston Metropolitan Statistical Area. We merged census-tract and school-level data from several sources, including the American Community Survey, the Health Resources and Services Administration, the Massachusetts Department of Public Health, and the U.S. Department of Education. Zero-inflated beta regression models were used to examine the association between schools' locations in medically underserved areas (MUAs) and the out-of-school suspension rates of students qualifying for special education services in the 2013–14 school year. Nested models and mediation analysis were used to parse the effects of medical underservice and neighborhood poverty on suspension rates. ResultsThe suspension rate of students with disabilities was about 5 percentage points higher in schools located in medically underserved areas compared to schools that are not in MUAs, controlling for school- and neighborhood-level characteristics (z = 1.97, p < .05). Medical underservice significantly mediated the effect of neighborhood poverty on suspensions of students with disabilities (indirect effect, p < .05), accounting for 44% of the total effect of poverty. ConclusionsThe findings indicate that schools with limited geographic access to health care services may more likely to use suspension as a tool to manage the behavior of students with disabilities.

Surveillance of Congenital Heart Defects among Adolescents at Three U.S. Sites

The prevalence, co-morbidities, and healthcare utilization in adolescents with congenital heart defects (CHDs) is not well understood. Adolescents (11 to 19 years old) with a healthcare encounter between January 1, 2008 (January 1, 2009 for MA) and December 31, 2010 with a CHD diagnosis code were identified from multiple administrative data sources compiled at 3 US sites: Emory University, Atlanta, Georgia (EU); Massachusetts Department of Public Health (MA); and New York State Department of Health (NY). The estimated prevalence for any CHD was 4.77 (EU), 17.29 (MA), and 4.22 (NY) and for severe CHDs was 1.34 (EU), 3.04 (MA), and 0.88 (NY) per 1,000 adolescents. Private or commercial insurance was the most common insurance type for EU and NY, and Medicaid for MA. Inpatient encounters were more frequent in severe CHDs. Cardiac co-morbidities included rhythm and conduction disorders at 20% (EU), 46% (MA), and 9% (NY) as well as heart failure at 3% (EU), 15% (MA), and 2% (NY). Leading noncardiac co-morbidities were respiratory/pulmonary (22% EU, 34% MA, 16% NY), infectious disease (17% EU, 22% MA, 20% NY), non-CHD birth defects (12% EU, 23% MA, 14% NY), gastrointestinal (10% EU, 28% MA, 13% NY), musculoskeletal (10% EU, 32% MA, 11% NY), and mental health (9% EU, 30% MA, 11% NY). In conclusion, this study used a novel approach of uniform CHD definition and variable selection across administrative data sources in 3 sites for the first population-based CHD surveillance of adolescents in the United States. High resource utilization and co-morbidities illustrate ongoing significant burden of disease in this vulnerable population.

Neighborhood Greenness Attenuates the Adverse Effect of PM2.5 on Cardiovascular Mortality in Neighborhoods of Lower Socioeconomic Status.

Features of the environment may modify the effect of particulate matter ≤2.5 µm in aerodynamic diameter (PM2.5) on health. Therefore, we investigated how neighborhood sociodemographic and land-use characteristics may modify the association between PM2.5 and cardiovascular mortality. We obtained residence-level geocoded cardiovascular mortality cases from the Massachusetts Department of Public Health (n = 179,986), and PM2.5 predictions from a satellite-based model (2001–2011). We appended census block group-level information on sociodemographic factors and walkability, and calculated neighborhood greenness within a 250 m buffer surrounding each residence. We found a 2.54% (1.34%; 3.74%) increase in cardiovascular mortality associated with a 10 µg/m3 increase in two-day average PM2.5. Walkability or greenness did not modify the association. However, when stratifying by neighborhood sociodemographic characteristics, smaller PM2.5 effects were observed in greener areas only among cases who resided in neighborhoods with a higher population density and lower percentages of white residents or residents with a high school diploma. In conclusion, the PM2.5 effects on cardiovascular mortality were attenuated by higher greenness only in areas with sociodemographic features that are highly correlated with lower socioeconomic status. Previous evidence suggests health benefits linked to neighborhood greenness may be stronger among lower socioeconomic groups. Attenuation of the PM2.5–mortality relationship due to greenness may explain some of this evidence.

First Person: Howard Koh, MD, MPH: Physician devotes his career to improving public health on many fronts.

First Person: Howard Koh, MD, MPH: Physician devotes his career to improving public health on many fronts.

Population-based surveillance of congenital heart defects among adolescents and adults: surveillance methodology.

Improved treatment of congenital heart defects (CHDs) has increased survival of persons with CHDs; however, no U.S. population-based systems exist to assess prevalence, healthcare utilization, or longer-term outcomes among adolescents and adults with CHDs. Novel approaches identified individuals aged 11-64 years who received healthcare with ICD-9-CM codes for CHDs at three sites: Emory University in Atlanta, Georgia (EU), Massachusetts Department of Public Health (MA), New York State Department of Health (NY) between January 1, 2008 (2009 for MA) and December 31, 2010. Case-finding sources included outpatient clinics; Medicaid and other claims data; and hospital inpatient, outpatient, and emergency visit data. Supplemental information came from state vital records (EU, MA), and birth defects registries (EU, NY). Demographics and diagnostic and procedural codes were linked, de-duplicated, and shared in a de-identified dataset. Cases were categorized into one of five mutually exclusive CHD severity groups; non-cardiac comorbidity codes were grouped into broad categories. 73,112 individuals with CHD codes in healthcare encounters were identified. Primary data source type varied: clinics (EU, NY for adolescents), claims (MA), hospital (NY for adults). There was a high rate of missing data for some variables and data varied in format and quality. Some diagnostic codes had poor specificity for CHD ascertainment. To our knowledge, this is the first population-based, multi-site CHD surveillance among adolescents and adults in the U.S. Identification of people living with CHDs through healthcare encounters using multiple data sources was feasible, though data quality varied and linkage/de-duplication was labor-intensive.

Lead Exposure, Concentrated Disadvantage, and Violent Crime Rates

Lead is an environmental toxin that contributes to several health and neurological development problems, with young children particularly at risk. Research shows that elevated blood lead levels (EBLLs) are higher in communities characterized by concentrated disadvantage. However, studies have provided conflicting evidence regarding the relationship between concentrated disadvantage, lead exposure, and crime rates. We analyzed data from the Massachusetts Department of Public Health, Census Bureau, and Boston Police Department to help address several issues in the literature. Specifically, we examined EBLLs at the census tract level and accounted for the percentage of homes built before 1979 to overcome previous research limitations regarding lead exposure measures, unit of analysis, and omitted variables. Our findings revealed that (1) the impact of concentrated disadvantage on EBLL rates was exacerbated by the amount of pre-1979 housing, and (2) concentrated disadvantage intensified the effect of EBLLs on crime rates, but only after accounting for pre-1979 housing.

Transfusion‐transmitted babesiosis: one state's experience

The risk for tickborne exposure to Babesia microti infection exists statewide in Massachusetts. Broad exposure complicates investigations of transfusion-transmitted babesiosis (TTB). We summarize 8 years of the epidemiology of TTB and highlight the role of public health in prevention and control. Cases of babesiosis are routinely reported to the Massachusetts Department of Public Health. These are investigated to determine whether they meet the surveillance case definition and to identify whether they were potentially transfusion transmitted. Frequencies from 2009 to 2016 are described and incidence rates calculated using population denominators from the US census. Changes over time were analyzed using simple linear regression. From 2009 to 2016, there were 2578 cases of babesiosis reported; of these, 45 (1.7%) were transfusion transmitted. Of the 45 cases of TTB, 15 (33%) received blood products from two or more suppliers. In 11 TTB cases, the Department of Public Health was notified first, who in turn notified the appropriate blood provider. In 2009, the crude rate of reported babesiosis was 1.2 per 100,000 population and increased significantly through 2016 to 7.8 per 100,000 population (p = 0.006). The number of blood donors reported with laboratory evidence of B. microti infection increased from 19 in 2012 to 78 in 2016; at the same time, the number of TTB cases decreased from six to three. TTB remains a major challenge, and blood donor screening strategies are currently in the process of implementation. While population and environmental changes facilitate increases in babesiosis, donor screening has the potential to eliminate TTB.