Morbidity And Mortality Weekly Report Research Articles

CDC: Dramatic increase in OD deaths from smoking opioids/stimulants

In a Morbidity and Mortality Weekly Report (MMWR) released last week, the federal Centers for Disease Control and Prevention (CDC) reported that overdose (OD) deaths from smoking illegally manufactured fentanyls and fentanyl analogs have increased dramatically, from 13.3% to 232.1% from 2020 to 2022. The study, “Routes of drug use among drug overdose deaths — United States, 2020‐2022” is by Lauren J. Tanz, ScD, and colleagues at the CDC and the Oak Ridge Institute for Science and Education.

An Analysis of Studies Pertaining to Masks in Morbidity and Mortality Weekly Report: Characteristics and Quality of Studies through 2023

BackgroundThe purpose of this study was to describe and evaluate the nature and methodology of reports and appropriateness of conclusions in The Morbidity and Mortality Weekly Report (MMWR) pertaining to masks. Because MMWR has substantial influence on United States health policy and is not externally peer-reviewed, it is critical to understand the scientific process within the journal. Mask policies have been highly influenced by data published in the MMWR. MethodsRetrospective cross-sectional study of MMWR publications pertaining to masks through 2023. Outcomes included study design, whether the study was able to assess mask effectiveness, if results were statistically significant, if masks were concluded to be effective, if randomized evidence or conflicting data were mentioned or cited, and appropriateness of causal statements. ResultsThere were 77 studies, all published after 2019, that met our inclusion criteria. The most common study design was observational without a comparator group: 22/77 (28.6%); 0/77 were randomized; 23/77 (29.9%) assessed mask effectiveness; 11/77 (14.3%) were statistically significant, but 58/77 (75.3%) stated that masks were effective. Of these, 41/58 (70.7%) used causal language. One mannequin study used causal language appropriately (1.3%). None cited randomized data; 1/77 (1.3%) cited conflicting evidence. ConclusionsMMWR publications pertaining to masks drew positive conclusions about mask effectiveness >75% of the time despite only 30% testing masks and <15% having statistically significant results. No studies were randomized, yet over half drew causal conclusions. The level of evidence generated was low and the conclusions were most often unsupported by the data. Our findings raise concern about the reliability of the journal for informing health policy.

Increasing Parechovirus Central Nervous System Infections and the Enduring Value of Clinical Microbiology Laboratories.

In early spring 2022, clinical microbiologists in Tennessee noticed an increasing trend of parechovirus (PeV) central nervous system (CNS) infections in infants <3 months through routine monitoring of test results for quality assurance. This initiated a discussion on ClinMicroNet, an online forum for clinical microbiologists supported by the American Society of Microbiology (ASM), about the unseasonably early circulation of PeV and increased CNS infections. Additional microbiologists in the United States noted similar trends, though reports differed by geographic region. The Tennessee trend was reported to the Tennessee Department of Health and then to the Centers for Disease Control and Prevention (CDC). These and other observations prompted release of a CDC Health Alert Network Health Advisory on July 12, 2022, which warned of increased PeV-A3 circulation in the United States. The CDC Health Advisory recommended inclusion of PeV in the differential for patients, particularly infants, with meningoencephalitis during seasons of high transmission (summer and fall). Notably, the presentation of meningoencephalitis in the Tennessee cases differed from conventional presentations in that cerebrospinal fluid pleocytosis was absent in most of the children. A case series of the Tennessee patients was thereafter reported in the CDC Morbidity and Mortality Weekly Report (MMWR), detailing 23 PeV CNS infections detected with a US Food and Drug Administration-approved multiplex molecular panel in infants <3 months over 6 weeks (1).

Beating Corona Virus Disease (COVID-19) in Newborns, Infants and Toddlers.

Madam, Corona Virus Disease (COVID-19), a pandemic, has been a global concern and it is a highly contagious respiratory illness that has been fatal to around 6 million lives. Although everyone is prone to get infected by COVID-19, the fact that is often overlooked is that newborns, infants and toddlers are as likely to get COVID-19 as adults. Babies younger than one year old might have a higher chance to get COVID-19 than older children. (1) According to a case report by Alzamora et al. mother infected with COVID-19 can also, in sporadic cases, pass the disease to her baby. (2) Infants are also at risk of getting infected shortly after birth, reason being exposure to sick caregivers. Most newborn, infants and toddlers who fall prey to COVID-19 have mild or no symptoms engendering many new cases, but serious cases have also occurred leading to hospitalization. Hospitalization is associated more with the omicron variant than the delta variant. According to Morbidity and Mortality Weekly Report (MMWR) by the Centrs for Disease Control and Prevention (CDC), hospitalization of U.S. infants and children aged 0-4 years was five times more during omicron predominance than during delta surge. (3) To overcome such cases, CDC recommends COVID-19 vaccine and backs Pfizer’s and Moderna’s COVID-19 shots for children aged six month to five years. (4) These vaccines can prevent complications like Multisystem Inflammatory Syndrome and Long COVID, which can be debilitating for young children. Vaccination can also protect children, which in turn minimize the possibility of transmission of disease to others. Furthermore, U.S. Food and Drug Administration (FDA) has also expanded the approval of the COVID-19 treatment Velkury (Remdesivir) to include pediatric patients 28 days of age and older weighing at least 3 kilograms with positive results of direct SARS-CoV-2 viral testing. (5) With COVID-19 rearing its head again in Pakistan, vaccination of vulnerable populations like newborns, infants and toddlers must be an urgent step to stem the spread of virus because tomorrow may be too late. Besides, Remdesivir, which was previously approved for certain adults, can now be put to good use for treating infants as young as 28 days old so that progression in hospitalization and critical illness in pediatric patients of Pakistan be cut down.

2022 adult immunization schedule updates

Each year, the U.S. Centers for Disease Control and Prevention (CDC) releases the adult vaccine schedule. The 2022 adult vaccine schedule has several changes which will be discussed in the following manuscript. The Advisory Committee on Immunization Practices reviews the preliminary schedules usually at their October or November meetings. The following professional societies also approve the adult schedules prior to the 2022 publications: American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM), American Academy of Physician Assistants (AAPA) and the Society for Healthcare Epidemiology of America (SHEA). Once the final draft is approved by the CDC, it is published in the Morbidity and Mortality Weekly Report (MMWR) and released to healthcare providers and the general public with a cover page, tables, notes and—new for the 2022 schedule—an appendix with contraindications and precautions for the different approved vaccines.

Epidemic Rates of Child and Adolescent Mental Health Disorders Require an Urgent Response

A new Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) documents the high prevalence of mental health disorders among America's children even before the pandemic.1 Pandemic era reports recently led the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children's Hospital Association (CHA) to issue a joint declaration of a national emergency in child and adolescent mental health.2 This new MMWR represents remarkable work compiling diverse information from nine nationally-representative data sets. Findings indicate high rates of mental health disorders among US children and youth, including evidence that even very young children experience mental health conditions. Twenty percent of all children have an identified mental health condition annually while forty percent of all children will meet criteria by age 18. MMWR findings show that children living in poverty and minoritized children fare worse than their peers in access to care, identifiable risk factors, and prevalence of certain mental health conditions. Despite high rates of mental health conditions, the MMWR documents low rates of treatment (about 11.4% annually for White, 9.8% for Black, and 8.7% for LatinX children).

Recommended Adult Immunization Schedule, United States, 2022.

Recommended Adult Immunization Schedule, United States, 2022.

Trends in Nationally Notifiable Sexually Transmitted Disease Case Reports During the US COVID-19 Pandemic, January to December 2020.

To describe changes in reported sexually transmitted diseases (STDs) during the US coronavirus disease 2019 pandemic, we compared the weekly number of reported nationally notifiable STDs in 2020 to 2019. We reviewed cases of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis reported to the US National Notifiable Disease Surveillance System in 2020. For each STD, we compare the number of 2020 cases reported for a given Morbidity and Mortality Weekly Report (MMWR) week to the number of 2019 cases reported in the same week, expressing 2020 cases as a percentage of 2019 cases. We also calculated the percent difference between 2020 and 2019 cumulative case totals as of MMWR week 50 (week of December 9). During MMWR weeks 1 to 11 (week of December 29, 2019-March 11, 2020), the weekly number of cases of STDs reported in 2020 as a percentage of the cases in the same week in 2019 was similar. However, 2020 numbers were much lower than 2019 numbers in week 15 (week of April 8; chlamydia, 49.8%; gonorrhea, 71.2%; and P&S syphilis, 63.7%). As of week 50, the 2020 cumulative totals compared with 2019 were 14.0% lower for chlamydia, 7.1% higher for gonorrhea, and 0.9% lower for P&S syphilis. During March-April 2020, national case reporting for STDs dramatically decreased compared with 2019. However, resurgence in reported gonorrhea and syphilis cases later in the year suggests STD reporting may have increased in 2020, underscoring the importance of continued STD prevention and care activities.

HIV: the next decade

40 years since the first published descriptions of disease caused by HIV, Talha Burki talks to some of the leading figures in the fight against HIV/AIDS about what must be achieved in the next decade. Marking 40 years of the HIV/AIDS responseIn June, 1981, a Morbidity and Mortality Weekly Report (MMWR) article briefly described five cases of Pneumocystis pneumonia among homosexual men in Los Angeles (CA, USA). This case series, which provides the first description of what came to be known as AIDS, takes just a minute or so to read but was the first tremor of a seismic upheaval in global health that continues to reverberate four decades on. Full-Text PDF

Centers for Disease Control and Prevention non-occupational noise campaign

In February 2017, an intra-agency workgroup within the Centers for Disease Control and Prevention (CDC) National Center for Environmental Health (NCEH) launched a hearing loss campaign to increase awareness that excessive exposure to loud sounds outside of the working environment can lead to permanent noise-induced hearing loss (NIHL). The NCEH workgroup initiated research efforts and participated in activities to promote the prevention of NIHL from non-occupational noise exposures. This included the development of an online toolkit with infographics, videos, and other sharable media, several available in English and Spanish. Publication of CDC NIHL research has included peer-reviewed journals, partner articles and Morbidity and Mortality Weekly Report (MMWR) manuscripts. The CDC NIHL workgroup engages with various organizations and continues to analyze national data to prioritize public health needs in this area. CDC continues to develop communication materials, social media content, videos, and factsheets to support partners and other stakeholders. By providing evidence and education/health communication; through its partners CDC collaborates with other national efforts to increase awareness and behavioral change to prevent NIHL at home and in the community.

CDC Addresses Non-Occupational Noise-Induced Hearing Loss.

CDC Addresses Non-Occupational Noise-Induced Hearing Loss.

Sources of human infection by Salmonella enterica serotype Javiana: A systematic review.

Non-typhoidal Salmonella (NTS) infection is one of the major causes of diarrheal disease throughout the world. In recent years, an increase in human S. Javiana infection has been reported from the southern part of the United States. However, the sources and routes of transmission of this Salmonella serotype are not well understood. The objective of this study was to perform a systematic review of the literature to identify risk factors for human S. Javiana infection. Using PRISMA guidelines, we conducted a systematic search in Web of Science, PubMed, and the Morbidity and Mortality Weekly Report (MMWR). Searches returned 63 potential articles, of which 12 articles met all eligibility criteria and were included in this review. A review of the literature indicated that both food and non-food (such as animal contact) exposures are responsible for the transmission of S. Javiana infection to humans. Consumption of fresh produce (tomatoes and watermelons), herbs (paprika-spice), dairy products (cheese), drinking contaminated well water and animal contact were associated with human S. Javiana infections. Based on the findings of this study, control of human S. Javiana infection should include three factors, (a) consumption of drinking water after treatment, (b) safe animal contact, and (c) safe food processing and handling procedures. The risk factors of S. Javiana infections identified in the current study provide helpful insight into the major vehicles of transmission of S. Javiana. Eventually, this will help to improve the risk management of this Salmonella serotype to reduce the overall burden of NTS infection in humans.

SUICIDE IN LATE-LIFE: COLLABORATIVE APPROACHES FOR ASSESSMENT, PREVENTION, AND TREATMENT: Session 202

According to the most recent Centers for Disease Control (CDC) Morbidity and Mortality Weekly Report (MMWR), the tenth leading cause of mortality is suicide. Suicide is one of three causes of death that continues to increase. The suicide rates have increased 30% since 1999. Older adults are at high risk for suicide in that they comprise 18% of all suicides but only 14.5% of the population (8000 suicides in 2015) (CDC). Literature suggests that while older adults have fewer suicide attempts, they have a higher suicide completion rate than younger adults. Considering this high rate of suicide completion, suicide prevention is imperative. Older adults tend to seek treatment from primary care providers than mental health clinicians and are less likely to discuss depression and/or suicide than their younger counterparts. Seventy-three percent of older adults that died by suicide visited a primary care provider within one month prior to their death. Literature indicates that depressed older adults receiving collaborative care within the primary care setting have better outcomes related to depression and suicidal ideations. Therefore, all healthcare professionals who treat older adults need to be aware of assessment and treatment of late-life suicide. In this symposium, we will describe the epidemiology of late-life suicide. In addition, we will discuss risk factors for suicide in late life and suicide assessment in the geriatric population. We will also review the collaborative approaches for prevention and treatment of late-life suicide.

Antiretroviral Therapies: Old Attitudes and New Perspectives in Dentistry

Antiretroviral Therapies: Old Attitudes and New Perspectives in Dentistry

Age-Standardized Mortality Rates in the Caribbean: One Source, Three Different Interpretations

PurposeA recent publication in Morbidity and Mortality Weekly Report (MMWR) provided the opportunity to calculate differences in published cancer mortality estimates for Caribbean jurisdictions from three organizations: MMWR, the International Agency for Research on Cancer, and the Institute for Health Metrics and Evaluation. This comparison study serves to educate end users of these data.MethodsWe downloaded the publicly available cancer mortality estimates for 15 jurisdictions and the United States from the three organizations. We compared reported age-standardized mortality rates for each jurisdiction and calculated the range among estimates for each jurisdiction. We repeated this analysis after applying the same world population standard to all estimates.ResultsFor males, the ranges of the Caribbean estimates were between 49% (Grenada and Trinidad) and 201% (US Virgin Islands) of the MMWR value, with an average of 88%. For females, the ranges were between 15% (Trinidad) and 171% (US Virgin Islands) of the MMWR value, with an average of 64%. After all estimates were compared using the same population standard, the ranges of the Caribbean estimates for males were between 6% (Grenada) and 111% (US Virgin Islands) of the MMWR value, with an average of 34%. For females, the ranges were between 7% (Grenada) and 97% (US Virgin Islands), with an average of 28%.ConclusionThe use of different standard populations complicates comparisons across organizations. Data modeling does not completely compensate for quality of source data, as our analysis demonstrated by the differences in mortality rates despite the good quality of the vital registration in the Caribbean.

Free-Text Mining to Improve Syndrome Definition Matching Across Emergency Departments

ObjectiveWe sought to use free text mining tools to improve emergency department (ED) chief complaint and discharge diagnosis data syndrome definition matching across facilities with differing robustness of data in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) application in Idaho’s syndromic surveillance system.IntroductionStandard syndrome definitions for ED visits in ESSENCE rely on chief complaints. Visits with more words in the chief complaint field are more likely to match syndrome definitions. While using ESSENCE, we observed geographic differences in chief complaint length, apparently related to differences in electronic health record (EHR) systems, which resulted in disparate syndrome matching across Idaho regions. We hypothesized that chief complaint and diagnosis code co-occurrence among ED visits to facilities with long chief complaints could help identify terms that would improve syndrome match among facilities with short chief complaints.MethodsThe ESSENCE-defined influenza-like illness (ILI) chief complaint syndrome was used as the base syndrome for this analysis. Syndrome-matched visits were defined as visits that match the syndrome definition.We assessed chief complaints and diagnosis code co-occurrence of syndrome-matched visits using the RCRAN TidyText package and developed a bigram network from normalized, concatenated chief complaint and diagnosis code (CCDD) fields and normalized diagnosis code (DD) fields per previously described methodologies.1 Common connections were defined by a natural break in frequency of pair occurrence for CCDD pairs (30 occurrences) and DD pairs (5 occurrences).The ESSENCE syndrome was revised by adding relevant bigram network clusters and logic operators. We compared time series of the percent of ED visits matched to the ESSENCE syndrome with those matched to the revised syndrome. We stratified the time series by facilities grouped by short (average &lt; 4 words, “Group A”) and long (average ≥ 4 words, “Group B”) chief complaint fields (Figure 1). Influenza season start was defined as two consecutive weeks above baseline, or the 95% upper confidence limit of percent syndrome-matched visits outside of the CDC ILI surveillance season. Season trends and influenza-related deaths in Idaho residents were compared.ResultsDuring August 1, 2016 through July 31, 2017, 1,587 (1.17%) of 135,789 ED visits matched the ESSENCE syndrome. Bigram networks of CCDD fields produced clusters already included by the ESSENCE syndrome. The bigram network of DD fields (Figure 2) produced six clusters. The revised syndrome definition included the ESSENCE syndrome, 3 single DD terms, and 3 two DD terms combined. The start of influenza season was identified as the same week for both ILI syndrome definitions (ESSENCE baseline 0.70%; revised baseline 2.21%). The ESSENCE syndrome indicated the season peaked during Morbidity and Mortality Weekly Report (MMWR) week 2017-05 with the season ending MMWR week 2017-14. The revised syndrome indicated 2017-20 as the season end. Multiple peaks seen with the revised syndrome during MMWR weeks 2017-02, 2017-05, and 2017-10 mirrored peaks in influenza-related deaths during MMWR weeks 2017-03, 2017-06, and 2017-11.ILI season onset was five weeks earlier with the revised syndrome compared with the ESSENCE syndrome in Group A facilities, but remained the same in Group B. The annual percentage of ED visits related to ILI was more uniform between facility groups under the revised syndrome than the ESSENCE syndrome. Unlike the trend seen with the ESSENCE syndrome, the revised syndrome shows low-level ILI activity in both groups year-round.ConclusionsIn Idaho, dramatic differences in ED visit chief complaint word counts were seen between facilities; bigram networks were found to be an important tool to identify diagnosis codes and logical operators that built more inclusive syndrome definitions when added to an existing chief complaint syndrome. Bigram networks may aid understanding the relationship between chief complaints and diagnosis codes in syndrome-matched visits.Use of trade names and commercial sources is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the U.S. Department of Health and Human Services.

Warning signs on stimulants

I think I am safe in suggesting that the Morbidity and Mortality Weekly Report (MMWR), published by the Centers for Disease Control and Prevention (CDC), is regularly read by few of our readers. While it has broadened its scope considerably over time, it retains much of its historical focus on infectious diseases and environmental exposures, with limited coverage of topics that might be of compelling interest to those of us in psychiatric medicine. However, my criteria for “compelling” were met by the MMWR paper by Anderson et al.1 that we cover as one of our lead articles in this month's issue.

Age-Standardized Mortality Rates in the Caribbean: One Source, Three Different Interpretations

Abstract 74 Purpose A recent publication in the Morbidity and Mortality Weekly Report (MMWR) provided the opportunity to calculate differences in published cancer mortality estimates for Caribbean jurisdictions from three organizations, MMWR, the International Agency for Research on Cancer, and the Institute for Health Metrics and Evaluation. This comparison study serves to educate end users of these data. Methods We downloaded the publicly available cancer mortality estimates for 15 jurisdictions and the United States from the three organizations. We compared reported age-standardized mortality rates for each jurisdiction, and calculated the range among the estimates for each jurisdiction. We repeated this analysis after applying the same world population standard to all estimates. Results For males, ranges of Caribbean estimates were between 49% (Grenada and Trinidad) and 201% (US Virgin Islands) of the MMWR value, with an average of 88%. For females, ranges were between 15% (Trinidad) and 171% (US Virgin Islands) of the MMWR value, with an average of 64%. After all estimates were compared using the same population standard, ranges of Caribbean estimates for males were between 6% (Grenada) and 111% (US Virgin Islands) of the MMWR value, with an average of 34%. For females, ranges were between 7% (Grenada) and 97% (US Virgin Islands), with an average of 28%. Conclusion The use of different standard populations complicates comparisons across organizations. Data modeling does not completely compensate for the quality of source data, as our analysis has demonstrated by the differences in mortality rates despite the good quality of the vital registration in the Caribbean. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Morbidity and Mortality Weekly Report (MMWR) Express and Making Healthy Choices Apps

Morbidity and Mortality Weekly Report (MMWR) Express and Making Healthy Choices Apps

Opioid Prescribing Falls But Still Remains High

Opioid Prescribing Falls But Still Remains High