Identifying Predictors of Physical Abuse Evaluation of Injured Infants: Opportunities to Improve Recognition.

OBJECTIVES: To identify predictors of physical abuse evaluation in infants younger than 6 months with visible injury and to determine the prevalence of occult fracture and intracranial hemorrhage in those evaluated. METHODS: Infants 6.0 months or younger who presented with visible injury to a pediatric hospital-affiliated emergency department or urgent care between July 2013 and January 2017 were included. Potential predictors included sociodemographics, treatment site, provider, injury characteristics, and history. Outcome variables included completion of a radiographic skeletal survey and identification of fracture (suspected or occult) and intracranial hemorrhage. RESULTS: Visible injury was identified in 378 infants, 47% of whom did not receive a skeletal survey. Of those with bruising, burns, or intraoral injuries, skeletal survey was less likely in patients 3 months or older, of black race, presenting to an urgent care or satellite location, evaluated by a non-pediatric emergency medicine-trained physician or nurse practitioner, or with a burn. Of these, 25% had an occult fracture, and 24% had intracranial hemorrhage. Occult fractures were also found in infants with apparently isolated abrasion/laceration (14%), subconjunctival hemorrhage (33%), and scalp hematoma/swelling (13%). CONCLUSIONS: About half of preambulatory infants with visible injury were not evaluated for physical abuse. Targeted education is recommended as provider experience and training influenced the likelihood of physical abuse evaluation. Occult fractures and intracranial hemorrhage were often found in infants presenting with seemingly isolated "minor" injuries. Physical abuse should be considered when any injury is identified in an infant younger than 6 months.

Parental Adverse Childhood Experiences and Pediatric Healthcare Use by 2 Years of Age.

OBJECTIVE: To determine whether maternal and paternal exposure to adverse childhood experiences (ACEs) has an association with offspring healthcare use by 2 years of age. STUDY DESIGN: A retrospective cohort study was performed on 454 patients at a large suburban pediatric primary care practice whose mother (n = 374) or father (n = 156) or both (n = 123) completed an ACE survey between October 2012 and June 2014. The association between self-reported parental ACEs and healthcare use by 2 years of age, including number of missed well-child visits, sick visits, and delayed or missed immunizations, was modeled using multivariable negative binomial regression. All analyses adjusted for child sex, payer source, and preterm birth. RESULTS: Maternal, but not paternal, ACE exposure was significantly associated with missed well-child visits by 2 years of age. For each additional maternal ACE, there was a significant 12% increase in the incidence rate of missed well-child visits (relative risk, 1.12; 95% CI, 1.03-1.22; P = .010). Maternal and paternal ACE scores were not significantly associated with increased sick visits or delayed or missed immunizations. CONCLUSIONS: The ACE exposure of mothers is negatively associated with adherence to preventive healthcare visits among their children early in life. Future research is needed to elucidate the mechanisms of this association and to develop and implement family-based intervention strategies.

Molecular Confirmation of Rocky Mountain Spotted Fever Epidemic Agent in Mexicali, Mexico.

Since 2008, a large epidemic of Rocky Mountain spotted fever has been emerging among humans and dogs in Mexicali, adjacent to the United States in Baja California, Mexico. We molecularly confirmed the causative agent; this information can be used to study the origin and dynamics of the epidemic.

Host, habitat and climate preferences of Ixodes angustus (Acari: Ixodidae) and infection with Borrelia burgdorferi and Anaplasma phagocytophilum in California, USA.

The Holarctic tick Ixodes angustus is a competent vector for Borrelia burgdorferi, the etiologic agent of Lyme disease, and possibly Anaplasma phagocytophilum, the etiologic agent of granulocytic anaplasmosis, as well. From 2005 to 2013, we collected host-feeding I. angustus individuals from live-trapped small mammals and by flagging vegetation from 12 study sites in northern and central California, and tested for B. burgdorferi sensu lato, A. phagocytophilum, and Rickettsia spp. DNA by real-time PCR. Among 261 I. angustus collected (259 from hosts and two by flagging), the most common hosts were tree squirrels (20 % of ticks) and chipmunks (37 %). The PCR-prevalence for A. phagocytophilum and B. burgdorferi in ticks was 2 % and zero, respectively. The minimum infection prevalence on pooled DNA samples was 10 % for Rickettsia spp. DNA sequencing of the ompA gene identified this rickettsia as Candidatus Rickettsia angustus, a putative endosymbiont. A zero-inflated negative binomial mixed effects model was used to evaluate geographical and climatological predictors of I. angustus burden. When host species within study site and season within year were included in the model as nested random effects, all significant variables revealed that I. angustus burden increased as temperature decreased. Together with published data, these findings suggest that I. angustus is a host generalist, has a broad geographic distribution, is more abundant in areas with lower temperature within it's range, and is rarely infected with the pathogens A. phagocytophilum and B. burgdorferi.

Glove perforation rate with orthopedic gloving versus double gloving technique in tibial plateau leveling osteotomy: A randomized trial.

In this randomized, prospective study, perforation rates, glove change rates, and cost between orthopedic gloves (n = 227) and double gloving with standard latex surgical gloves (n = 178) worn in tibial plateau leveling osteotomy procedures were compared. Gloves were collected from the surgeon and surgical resident after procedures and were tested for perforations with a standardized water leak test, as described by the American Society for Testing and Materials International. No statistically significant difference was found between the perforation rate using orthopedic gloving and double gloving techniques (P = 0.629) or the rate at which gloves were changed (P = 0.146). Orthopedic gloving was 2.1 times more costly than double gloving but they may be preferred by surgeons for dexterity and comfort.

Taux de perforation des gants avec le gantage orthopédiquepar oppositionà une technique de double gantage pour l'ostéotomie de nivellement du plateau tibial : un essai randomisé. Dans cette étude prospective randomisée, les taux de perforation, les taux de changement des gants et le coût des gants orthopédiques (n = 227) et du double gantage avec des gants de chirurgie au latex standard (n = 178) portés dans les interventions d'ostéotomie du nivellement du plateau tibial ont été comparés. Les gants ont été recueillis auprès du chirurgien et du résident en chirurgie après les interventions et ils ont été testés pour les perforations à l'aide d'un test de fuite normalisé, tel que décrit par l'American Society for Testing and Materials International. Aucune différence statistique n'a été constatée entre le taux de perforation à l'aide des techniques de gants orthopédiques et du double gantage (P = 0,629) ou le taux de remplacement des gants (P = 0,146). Le gantage orthopédique était 2,1 fois plus cher que le double gantage mais il peut être privilégié par les chirurgiens car il offre plus de dextérité et de confort.(Traduit par Isabelle Vallières).

Mange Caused by a Novel Micnemidocoptes Mite in a Golden Eagle ( Aquila chrysaetos ).

A second-year, female golden eagle ( Aquila chrysaetos ) was live trapped in northern California because of severe feather loss and crusting of the skin on the head and legs. On physical examination, the bird was lethargic, dehydrated, and thin, with severe feather loss and diffuse hyperemia and crusting on the head, ventral wings, ventrum, dorsum, and pelvic limbs. Mites morphologically similar to Micnemidocoptes derooi were identified with scanning electron microscopy. The eagle was treated with ivermectin (0.4 mg/kg) once weekly for 7 weeks, as well as pyrethrin, meloxicam, ceftiofur crystalline free acid, and voriconazole. Although the eagle's condition improved, and live mites or eggs were not evident on skin scrapings at the time of completion of ivermectin treatment, evidence of dead mites and mite feces were present after the last dose of ivermectin. Two additional doses of ivermectin and 2 doses of topical selamectin (23 mg/kg) were administered 2 and 4 weeks apart, respectively. No mite eggs, feces, or adults were evident after treatment was completed. A second golden eagle found in the same region was also affected with this mite but died soon after presentation. This is the first report, to our knowledge, of successful treatment, as well as treatment with selamectin, of mites consistent with Micnemidocoptes species in any raptorial species.

Knemidocoptic mange in wild golden eagles, California, USA.

During 2012-2013 in California, USA, 3 wild golden eagles were found with severe skin disease; 2 died. The cause was a rare mite, most closely related to Knemidocoptes derooi mites. Cautionary monitoring of eagle populations, habitats, and diseases is warranted.

Retrospective risk factor assessment for complication following tibial tuberosity transposition in 137 canine stifles with medial patellar luxation.

This study identified risk factors for complication following tibial tuberosity transposition by retrospective examination of cases that used various surgical techniques. Records and radiographs of 113 dogs with 137 stifles undergoing tibial tuberosity transposition for medial patellar luxation were reviewed. Patient-specific factors, surgical factors, and complication information were recorded. Owners were contacted as necessary to attain a minimum of 30 days follow-up. Of 137 stifles, 59 (43%) had complications, with 24 (18%) identified as major complications. Factors significantly associated with reduced risk of complication included increased age [odds ratio (OR) 0.8] and concurrent cranial cruciate ligament rupture (OR 0.3). Factors significantly associated with increased risk of complication included large breed compared to toy breed (OR 5.5), increased weight (OR 1.3), and use of a screw for tibial tuberosity fixation (OR infinity). While significant, these associations do not imply causality and prospective study is necessary to determine the ideal fixation method for individual patients.

Évaluation rétrospective du facteur de risque pour une complication après une transposition de la tubérosité tibiale à l'aide de diverses techniques chirurgicales dans 137 grassets atteints d'une luxation patellaire médiale. Cette étude a identifié les facteurs de risque pour une complication après la transposition de la tubérosité tibiale en effectuant l'examen rétrospectif de cas qui utilisaient des techniques chirurgicales diverses. Les dossiers et les radiographies de 113 chiens avec 137 grassets subissant une transposition de la tubérosité tibiale pour une luxation patellaire médiale ont été examinés. Les facteurs particuliers des patients, les facteurs chirurgicaux et les renseignements sur les complications ont été consignés. Au besoin, on a contacté les propriétaires pour obtenir un suivi d'au moins 30 jours. Parmi les 137 grassets, 59 (43 %) ont connu des complications et 24 (18 %) ont été identifiés comme des complications majeures. Les facteurs significativement associés à un risque réduit de complication incluaient un âge avancé [rapport de cotes (RC) de 0,8] et une rupture du ligament croisé antérieur (RC 0,3). Les facteurs qui étaient significativement associés à un risque de complication incluaient les grandes races comparativement aux races de petits chiens (RC 5,5), un poids supérieur (RC 1,3) et l'utilisation d'une vis pour la fixation de la tubérosité tibiale (RC infini). Même si elles étaient importantes, ces associations n'impliquaient pas la causalité et une étude prospective est nécessaire pour déterminer la méthode de fixation idéale pour les patients individuels.(Traduit par Isabelle Vallières).

The experience of parenting a child with dyslexia - A UK perspective with single parents.

Dyslexia is a specific learning difficulty that affects the development of literacy and language-related skills, unrelated to intellectual ability. While the impact of parenting an individual with dyslexia (IWD) for married parents has been widely studied, little is known about the impact on single parents. This study explored the lived experiences of single parents of an IWD. Six female participants completed semi-structured interviews discussing their experience of the diagnostic process, support received and general parenting perspectives. Interview transcripts were analysed using Interpretative Phenomenological Analysis. Three main themes were identified: Navigating the diagnosis; Various levels of support; Battling Misconceptions and Lack of Knowledge. Findings suggested that single parents had a mixed experience, both after receiving the diagnosis and in terms of the support they received from family and schools. Differences in the quality of statutory support were highlighted, implicating the need for improved dyslexia support in schools. Unique challenges of parenting an IWD as a single parent were also identified, highlighting important implications. Future research should explore differences in single fathers' experiences and the impact of dyslexia comorbidities on single parents.

Pediatric pulmonology 2021 year in review: Asthma.

Asthma is the most common chronic disease in children, affecting an estimated 6.1 million children in the United States. SARS-CoV2 had a significant impact on asthma exacerbations and healthcare utilization of patients with asthma in 2021. Additionally, studies in 2021 influenced the field of asthma with improvements in diagnostic testing and monitoring, treatment of severe exacerbations, social determinants of health, and evaluation of medical costs. This article is part of our 2021 "Year in Review" series, in which we summarize publications in major pulmonary topics, in the context of selected literature from other journals relevant to our discipline.

Pediatric pulmonology 2022 year in review: Asthma.

In 2022, new research studies influenced the field of pediatric asthma with improvements in diagnosis and evaluation; new treatment options including biologic therapies; changes in risk factors for asthma; and increased discussion about the impact of social determinants of health on asthma. Additionally, three years after the start of the COVID-19 pandemic, we continue to see the impact of SARS-CoV-2 virus on pediatric asthma care. In this review article, we summarize the significant findings from publications in Pediatric Pulmonology and other relevant journals from the last year. We hope this review will provide new insight within the field of pediatric asthma, as well as guidance for implementation into clinical practice.

Historical trends demonstrate a pattern of increasingly frequent and severe spillover events of high-consequence zoonotic viruses.

The COVID-19 pandemic has focused attention on patterns of infectious disease spillover. Climate and land-use changes are predicted to increase the frequency of zoonotic spillover events, which have been the cause of most modern epidemics. Characterising historical trends in zoonotic spillover can provide insights into the expected frequency and severity of future epidemics, but historical epidemiological data remains largely fragmented and difficult to analyse. We utilised our extensive epidemiological database to analyse a specific subset of high-consequence zoonotic spillover events for trends in the annual frequency and severity of outbreaks. Our analysis, which excludes the ongoing SARS-CoV-2 pandemic, shows that the number of spillover events and reported deaths have been increasing by 4.98% (confidence interval [CI]95% [3.22%; 6.76%]) and 8.7% (CI 95% [4.06%; 13.62%]) annually, respectively. This trend can be altered by concerted global efforts to improve our capacity to prevent and contain outbreaks. Such efforts are needed to address this large and growing risk to global health.

Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce: An Official American Thoracic Society Workshop Report.

Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.

Infectious Disease Underreporting Is Predicted by Country-Level Preparedness, Politics, and Pathogen Severity.

Underreporting of infectious diseases is a pervasive challenge in public health that has emerged as a central issue in characterizing the dynamics of the COVID-19 pandemic. Infectious diseases are underreported for a range of reasons, including mild or asymptomatic infections, weak public health infrastructure, and government censorship. In this study, we investigated factors associated with cross-country and cross-pathogen variation in reporting. We performed a literature search to collect estimates of empirical reporting rates, calculated as the number of cases reported divided by the estimated number of true cases. This literature search yielded a dataset of reporting rates for 32 pathogens, representing 52 countries. We combined epidemiological and social science theory to identify factors specific to pathogens, country health systems, and politics that could influence empirical reporting rates. We performed generalized linear regression to test the relationship between the pathogen- and country-specific factors that we hypothesized could influence reporting rates, and the reporting rate estimates that we collected in our literature search. Pathogen- and country-specific factors were predictive of reporting rates. Deadlier pathogens and sexually transmitted diseases were more likely to be reported. Country epidemic preparedness was positively associated with reporting completeness, while countries with high levels of media bias in favor of incumbent governments were less likely to report infectious disease cases. Underreporting is a complex phenomenon that is driven by factors specific to pathogens, country health systems, and politics. In this study, we identified specific and measurable components of these broader factors that influence pathogen- and country-specific reporting rates and used model selection techniques to build a model that can guide efforts to diagnose, characterize, and reduce underreporting. Furthermore, this model can characterize uncertainty and correct for bias in reported infectious disease statistics, particularly when outbreak-specific empirical estimates of underreporting are unavailable. More precise estimates can inform control policies and improve the accuracy of infectious disease models.

Challenges in reported COVID-19 data: best practices and recommendations for future epidemics.

The proliferation of composite data sources tracking the COVID-19 pandemic emphasises the need for such databases during large-scale infectious disease events as well as the potential pitfalls due to the challenges of combining disparate data sources. Multiple organisations have attempted to standardise the compilation of disparate data from multiple sources during the COVID-19 pandemic. However, each composite data source can use a different approach to compile data and address data issues with varying results.We discuss some best practices for researchers endeavouring to create such compilations while discussing three key categories of challenges: (1) data dissemination, which includes discrepant estimates and varying data structures due to multiple agencies and reporting sources generating public health statistics on the same event; (2) data elements, such as date formats and location names, lack standardisation, and differing spatial and temporal resolutions often create challenges when combining sources; and (3) epidemiological factors, including missing data, reporting lags, retrospective data corrections and changes to case definitions that cannot easily be addressed by the data compiler but must be kept in mind when reviewing the data.Efforts to reform the global health data ecosystem should bear such challenges in mind. Standards and best practices should be developed and incorporated to yield more robust, transparent and interoperable data. Since no standards exist yet, we have highlighted key challenges in creating a comprehensive spatiotemporal view of outbreaks from multiple, often discrepant, reporting sources and provided guidelines to address them. In general, we caution against an over-reliance on fully automated systems for integrating surveillance data and strongly advise that epidemiological experts remain engaged in the process of data assessment, integration, validation and interpretation to identify, diagnose and resolve data challenges.

Borrelia burgdorferi and Anaplasma phagocytophilum Genospecies in Northern California.

The sensu lato (s.l.) complexes of Borrelia burgdorferi and Anaplasma phagocytophilum include pathogenic genospecies each with distinct ecologies in northern California, yet, most work conflates the genospecies of each pathogen into one sensu lato species. Detailed understanding of the differences in geographic distributions and ecology among genospecies is lacking. We aimed to evaluate whether two B. burgdorferi and two A. phagocytophilum genospecies in high-risk locations in coastal northern California were spatially clustered and if presence of a particular genospecies was associated with geographical site, host species, or other demographic or ecological variables. DNA sequencing was performed to differentiate genospecies of Borreliae and Anaplasma from PCR-positive dusky-footed woodrats (Neotoma fuscipes) and sciurids (chipmunks, Tamias spp., and Douglas squirrels, Tamiasciurus douglasii) at four sites in northwestern California. Logistic regression was performed to assess associations of genospecies with the predictor variables host species, host sex, site, season, and year. Spatial clustering was assessed using a Poisson spatial scan statistic in SaTScan. Host species was a significant predictor for Borrelia bissettiae, B. burgdorferi sensu stricto (s.s.), A. phagocytophilum s.s., and the DU1 Anaplasma genospecies. Woodrats were significantly more likely to be PCR-positive for B. bissettiae and A. phagocytophilum DU1 genospecies, while A. phagocytophilum s.s. and B. burgdorferi s.s. were significantly associated with sciurids. We report a single Borrelia lanei in an Allen's chipmunk (Tamias senex) from the Hoopa Valley Tribal Reservation. A significant spatial cluster of A. phagocytophilum s.s. was detected at Hendy Woods State Park in Mendocino County. These results highlight the need to better understand genospecies partitioning according to host species to further assess human risks, aid in future surveillance, and inform targeted research.

Human Seroprevalence of Tick-Borne Anaplasma phagocytophilum, Borrelia burgdorferi, and Rickettsia Species in Northern California.

There is a paucity of data on human exposure to tick-borne pathogens in the western United States. This study reports prevalence of antibodies against three clinically important tick-borne pathogens (Borrelia burgdorferi, Anaplasma phagocytophilum, and Rickettsia spp.) among 249 people in five counties in northern California. Individuals from Humboldt County were recruited and answered a questionnaire to assess risk of exposure to tick-borne pathogens. Samples from other counties were obtained from a blood bank and were anonymized. Seventeen (6.8%) samples were seropositive for antibodies against at least one pathogen: five for A. phagocytophilum, eight for B. burgdorferi, and four for Rickettsia spp. Women and people aged 26-35 had higher seroprevalence compared to other demographic groups. Santa Cruz County had no seropositive individuals, northern Central Valley counties had three seropositive individuals (all against A. phagocytophilum), and Humboldt County had 14 (all three pathogens), a significant, four-fold elevated risk of exposure. The Humboldt County questionnaire revealed that a bird feeder in the yard was statistically associated with exposure to ticks, and lifetime number of tick bites was associated with increasing age, time watching wildlife, and time hiking. Three-quarters of respondents were concerned about tick-associated disease, 81.0% reported experiencing tick bites, and 39.0% of those bitten reported a tick-borne disease symptom, including skin lesions (76.4%), muscle aches (49.1%), joint pain (25.5%), or fever (23.6%). Despite high levels of concern, many individuals who had been bitten by a tick were not tested for a tick-borne pathogen, including those with consistent symptoms. We highlight the need for further research and dissemination of information to residents and physicians in Northern California regarding tick-associated disease, so that appropriate medical attention can be rapidly sought and administered.

Possible Northward Introgression of a Tropical Lineage of Rhipicephalus sanguineus Ticks at a Site of Emerging Rocky Mountain Spotted Fever.

Increasing rates of Rocky Mountain spotted fever (RMSF) in the southwestern United States and northern Mexico underscore the importance of studying the ecology of the brown dog tick, Rhipicephalus sanguineus, the vector in that region. This species is reported to comprise distinct tropical and temperate lineages that may differ in vectorial capacity for RMSF and are hypothesized to be limited in their geographical range by climatic conditions. In this study, lineage was determined for ticks from 9 locations in California, Arizona, and Mexico by DNA sequencing of 12S, 16S, and D-loop ribosomal RNA. As expected, sites in northern California and eastern Arizona had temperate-lineage ticks, and phylogenetic analysis revealed considerable genetic variability among these temperate-lineage ticks. However, tropical-lineage ticks extended north from Oaxaca, Mexico were well established along the entire border from San Diego, California to western Arizona, and were found as far north as Lytle Creek near Los Angeles, California (a site where both lineages were detected). Far less genetic variability in the tropical lineage despite the large geographical distances is supportive of a hypothesis of rapid northward expansion. Discovery of the tropical lineage north of the identified climatic limitations suggests that more work is needed to characterize this tick's ecology, vectorial capacity, expansion, possible evolution, and response to climate change.

Parental Adverse Childhood Experiences and Offspring Development at 2 Years of Age.

OBJECTIVES: The study objective was to determine if maternal and paternal exposure to adverse childhood experiences (ACEs) have a significant association with negative offspring development at 24 months of age in a suburban pediatric primary care population. METHODS: A retrospective cohort study was conducted of 311 mother-child and 122 father-child dyads who attended a large pediatric primary care practice. Children were born from October 2012 to June 2014, and data were collected at the 2-, 4-, and 24-month well-child visits. Multivariable Poisson regression with robust error variance was used to model the relationship between self-reported parental ACEs and the outcomes of suspected developmental delay at 24 months and eligibility for early intervention services. RESULTS: For each additional maternal ACE, there was an 18% increase in the risk for a suspected developmental delay (relative risk: 1.18, 95% confidence interval: 1.08-1.29). A similar trend was observed for paternal ACEs (relative risk: 1.34, 95% confidence interval: 1.07-1.67). Three or more maternal ACEs (versus <3 ACEs) was associated with a significantly increased risk for a suspected developmental delay that affected multiple domains. Similar effects were observed for early intervention services. CONCLUSIONS: Parental ACE exposures can negatively impact child development in multiple domains, including problem solving, communication, personal-social, and motor skills. Research is needed to elucidate the psychosocial and biological mechanisms of intergenerational risk. This research has implications for the value of parental ACE screening in the context of pediatric primary care.

Are disease reservoirs special? Taxonomic and life history characteristics.

Pathogens that spill over between species cause a significant human and animal health burden. Here, we describe characteristics of animal reservoirs that are required for pathogen spillover. We assembled and analyzed a database of 330 disease systems in which a pathogen spills over from a reservoir of one or more species. Three-quarters of reservoirs included wildlife, and 84% included mammals. Further, 65% of pathogens depended on a community of reservoir hosts, rather than a single species, for persistence. Among mammals, the most frequently identified reservoir hosts were rodents, artiodactyls, and carnivores. The distribution among orders of mammalian species identified as reservoirs did not differ from that expected by chance. Among disease systems with high priority pathogens and epidemic potential, we found birds, primates, and bats to be overrepresented. We also analyzed the life history traits of mammalian reservoir hosts and compared them to mammals as a whole. Reservoir species had faster life history characteristics than mammals overall, exhibiting traits associated with greater reproductive output rather than long-term survival. Thus, we find that in many respects, reservoirs of spillover pathogens are indeed special. The described patterns provide a useful resource for studying and managing emerging infectious diseases.