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The Los Angeles County Department of Public Health established a surveillance system to identify complicated (advanced human immunodeficiency virus [HIV] or hospitalized) mpox cases. From 1 August to 30 November 2022, we identified 1581 mpox cases, of which 134 (8.5%) were complicated. A subset of 8 cases did not recover after either initiating or completing a course of oral tecovirimat. All 8 patients were HIV positive and had advanced HIV (CD4 count <200 cells/µL). We identified 8 distinct mutations previously associated with tecovirimat resistance in specimens collected from 6 patients. Ongoing surveillance of viral evolution requires close coordination between health departments and frontline providers.
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Seropositividad para VIH , Mpox , Humanos , Los Angeles , Benzamidas , IsoindolesRESUMEN
Risk for transmission of monkeypox virus (MPXV) (clade IIb) to healthcare workers (HCWs) is low. Although many cases have been reported among HCW, only a few have been occupationally acquired. We report a case of non-needle stick MPXV transmission to an HCW in the United States.
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Monkeypox virus , Mpox , Humanos , Mpox/diagnóstico , Mpox/epidemiología , California/epidemiología , Personal de SaludRESUMEN
In Los Angeles County, California, USA, public health surveillance identified 118 mpox cases among persons experiencing homelessness (PEH) during July-September 2022. Age and sex were similar for mpox case-patients among PEH and in the general population. Seventy-one (60%) PEH mpox case-patients were living with HIV, 35 (49%) of them virally suppressed. Hospitalization was required for 21% of case-patients because of severe disease. Sexual contact was likely the primary mode of transmission; 84% of patients reported sexual contact <3 weeks before symptom onset. PEH case-patients lived in shelters, encampments, cars, or on the street, or stayed briefly with friends or family (couch surfed). Some case-patients stayed at multiple locations during the 3-week incubation period. Public health follow-up and contact tracing detected no secondary mpox cases among PEH in congregate shelters or encampments. Equitable efforts should continue to identify, treat, and prevent mpox among PEH, who often experience severe disease.
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Personas con Mala Vivienda , Mpox , Humanos , Los Angeles/epidemiología , Salud Pública , Trazado de ContactoRESUMEN
As of March 7, 2023, a total of 30,235 confirmed and probable monkeypox (mpox) cases were reported in the United States, predominantly among cisgender men§ who reported recent sexual contact with another man (1). Although most mpox cases during the current outbreak have been self-limited, cases of severe illness and death have been reported (2-4). During May 10, 2022-March 7, 2023, 38 deaths among persons with probable or confirmed mpox¶ (1.3 per 1,000 mpox cases) were reported to CDC and classified as mpox-associated (i.e., mpox was listed as a contributing or causal factor). Among the 38 mpox-associated deaths, 94.7% occurred in cisgender men (median age = 34 years); 86.8% occurred in non-Hispanic Black or African American (Black) persons. The median interval from symptom onset to death was 68 days (IQR = 50-86 days). Among 33 decedents with available information, 93.9% were immunocompromised because of HIV. Public health actions to prevent mpox deaths include integrated testing, diagnosis, and early treatment for mpox and HIV, and ensuring equitable access to both mpox and HIV prevention and treatment, such as antiretroviral therapy (ART) (5).
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Mpox , Adulto , Humanos , Masculino , Negro o Afroamericano , Brotes de Enfermedades , Mpox/mortalidad , Salud Pública , Estados Unidos/epidemiologíaRESUMEN
During July 2021, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.617.2 variant infections, including vaccine breakthrough infections, occurred after large public gatherings in Provincetown, Massachusetts, USA, prompting a multistate investigation. Public health departments identified primary and secondary cases by using coronavirus disease surveillance data, case investigations, and contact tracing. A primary case was defined as SARS-CoV-2 detected <14 days after travel to or residence in Provincetown during July 3-17. A secondary case was defined as SARS-CoV-2 detected <14 days after close contact with a person who had a primary case but without travel to or residence in Provincetown during July 3-August 10. We identified 1,098 primary cases and 30 secondary cases associated with 26 primary cases among fully and non-fully vaccinated persons. Large gatherings can have widespread effects on SARS-CoV-2 transmission, and fully vaccinated persons should take precautions, such as masking, to prevent SARS-CoV-2 transmission, particularly during substantial or high transmission.
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COVID-19 , Vacunas contra la COVID-19 , Brotes de Enfermedades , Humanos , Massachusetts , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
Data on monkeypox in children and adolescents aged <18 years are limited (1,2). During May 17September 24, 2022, a total of 25,038 monkeypox cases were reported in the United States, primarily among adult gay, bisexual, and other men who have sex with men (3). During this period, CDC and U.S. jurisdictional health departments identified Monkeypox virus (MPXV) infections in 83 persons aged <18 years, accounting for 0.3% of reported cases. Among 28 children aged 012 years with monkeypox, 64% were boys, and most had direct skin-to-skin contact with an adult with monkeypox who was caring for the child in a household setting. Among 55 adolescents aged 1317 years, most were male (89%), and male-to-male sexual contact was the most common presumed exposure route (66%). Most children and adolescents with monkeypox were non-Hispanic Black or African American (Black) (47%) or Hispanic or Latino (Hispanic) (35%). Most (89%) were not hospitalized, none received intensive care unit (ICU)level care, and none died. Monkeypox in children and adolescents remains rare in the United States. Ensuring equitable access to monkeypox vaccination, testing, and treatment is a critical public health priority. Vaccination for adolescents with risk factors and provision of prevention information for persons with monkeypox caring for children might prevent additional infections.
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Mpox , Niño , Animales , Adolescente , Humanos , Estados Unidos/epidemiología , Mpox/epidemiología , Zoonosis/epidemiología , Brotes de EnfermedadesRESUMEN
Phosphotyrosine residues are essential functional switches in health and disease. Thus, phosphotyrosine biomimetics are crucial for the development of chemical tools and drug molecules. We report here the discovery and investigation of pentafluorophosphato amino acids as novel phosphotyrosine biomimetics. A mild acidic pentafluorination protocol was developed and two PF5 -amino acids were prepared and employed in peptide synthesis. Their structures, reactivities, and fluorine-specific interactions were studied by NMR and IR spectroscopy, X-ray diffraction, and in bioactivity assays. The mono-anionic PF5 motif displayed an amphiphilic character binding to hydrophobic surfaces, to water molecules, and to protein-binding sites, exploiting charge and H-F-bonding interactions. The novel motifs bind 25- to 30-fold stronger to the phosphotyrosine binding site of the protein tyrosine phosphatase PTP1B than the best current biomimetics, as rationalized by computational methods, including molecular dynamics simulations.
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Flúor , Fenilalanina , Sitios de Unión , Biomimética , Inhibidores Enzimáticos/química , Fluoruros , Modelos Moleculares , Fosfotirosina/químicaRESUMEN
In December 2011 and December 2013, the Philadelphia Department of Public Health (PDPH) received separate reports of clusters of photokeratitis linked to gymnasium events. Photokeratitis, a painful eye condition resulting from unprotected exposure to ultraviolet radiation, has previously been linked to metal halide lamps with broken outer envelopes (1,2). To investigate the cause of these clusters and further characterize patients with photokeratitis, PDPH administered questionnaires to potentially exposed persons, established a case definition, and conducted environmental assessments of both gymnasiums. Because event attendee registration information was available, a cohort study was conducted to evaluate the 2011 cluster of 242 persons who met the photokeratitis case definition. A case-series investigation was conducted to evaluate the 2013 cluster of 20 persons who met the photokeratitis case definition for that event. These investigations indicated that Type R metal halide bulbs with broken outer envelopes found in both gymnasiums were the probable cause of the photokeratitis. The Food and Drug Administration has made a number of recommendations regarding the use of metal halide bulbs in facilities where bulbs are at elevated risk for breaking, such as schools and indoor sports facilities (3). Because Type R metal halide lamps do not self-extinguish once the outer envelope is broken, these bulbs should be removed from settings with a high risk for outer envelope rupture, such as gymnasiums, or should be placed within enclosed fixtures. In instances where these bulbs cannot be exchanged for self-extinguishing lamps, Type R lamps with a broken outer envelope should be replaced immediately to limit exposure to ultraviolet radiation. A broken outer envelope can be detected by the presence of glass on the floor, or visual examination of the bulb when the power is turned off. A broken outer envelope is difficult to detect when the lamp is emitting light.
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Brotes de Enfermedades/estadística & datos numéricos , Exposición a Riesgos Ambientales/efectos adversos , Queratitis/etiología , Iluminación/efectos adversos , Trastornos por Fotosensibilidad/etiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Halógenos , Humanos , Lactante , Recién Nacido , Queratitis/epidemiología , Masculino , Metales , Persona de Mediana Edad , Philadelphia/epidemiología , Trastornos por Fotosensibilidad/epidemiología , Adulto JovenRESUMEN
Conducting polymers such as polyaniline and polypyrrole have been widely used as pseudocapacitive electrode materials for supercapacitors. However, their structural instability resulting from repeated volumetric swelling and shrinking during charge/discharge process has been a major hurdle for their practical applications. This work demonstrates a simple and general strategy to substantially enhance the cycling stability of conductive polymer electrodes by deposition of a thin carbonaceous shell onto their surface. Significantly, carbonaceous shell-coated polyaniline and polypyrrole electrodes achieved remarkable capacitance retentions of â¼95 and â¼85% after 10,000 cycles. Electron microscopy studies revealed that the presence of â¼5 nm thick carbonaceous shell can effective prevent the structural breakdown of polymer electrodes during charge/discharge process. Importantly, the polymer electrodes with a â¼5 nm thick carbonaceous shell exhibited comparable specific capacitance and pseudocapacitive behavior as the bare polymer electrodes. We anticipate that the same strategy can be applied for stabilizing other polymer electrode materials. The capability of fabricating stable polymer electrodes could open up new opportunities for pseudocapacitive devices.
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We describe real-world estimates of JYNNEOS vaccine effectiveness (VE) against symptomatic mpox in Los Angeles County (LAC). We conducted a retrospective cohort study of men aged ≥18 years residing in LAC who were at risk for mpox and eligible for the JYNNEOS vaccine from 5/19/2022 to 1/1/2023. Case demographics and route of JYNNEOS administration were obtained through vaccine administration data systems. HIV and sexually transmitted infection (STI) status was obtained through disease reporting systems for HIV and STI diagnoses in LAC. To estimate VE, we calculated weekly incidence of confirmed mpox for unvaccinated, partially vaccinated (episode date ≥14 days after first dose), and fully vaccinated (episode date ≥14 days after second dose) cohorts starting on 8/29/2022, when fully vaccinated coverage exceeded 3 %, and ending on 1/1/2023. Overall, 2,171 men had confirmed mpox, and 1,002 (46 %) of those were persons living with diagnosed HIV (PLWDH). 2,019 (93 %) mpox cases were unvaccinated, 114 (5 %) were partially vaccinated and 38 (2 %) were fully vaccinated. VE was 69 % (95 % CI 59-77) for partially vaccinated and 84 % (95 % CI 80-87) for fully vaccinated individuals. Among PLWDH, VE was 72 % (95 % CI 57-82) for fully vaccinated and 28 % (95 % CI -96 to 73) VE for partially vaccinated individuals. Among persons not living with diagnosed HIV, VE was 88 % (95 % CI 86-90) for fully vaccinated and 80 % (95 % CI 76-83) for partially vaccinated individuals. Of 111 individuals hospitalized with mpox, one was partially vaccinated, and the remaining were unvaccinated. Our results align with other published studies that reported that two doses of the JYNNEOS vaccine provided significant protection against symptomatic mpox.
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Eficacia de las Vacunas , Humanos , Masculino , Adulto , Estudios Retrospectivos , Los Angeles/epidemiología , Persona de Mediana Edad , Adulto Joven , Infecciones por VIH/prevención & control , Adolescente , Vacunación/estadística & datos numéricos , Incidencia , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/epidemiología , Vacunas contra la COVID-19/inmunología , Vacunas contra la COVID-19/administración & dosificaciónRESUMEN
We describe the epidemiology of COVID-19 exposure, preceding illness, and SARS-CoV-2 testing in a large population with MIS-C during the first 18 months of the COVID-19 pandemic. The majority of cases had exposure, preceding illness, or positive SARS-CoV-2 testing 4-8 weeks before MIS-C onset. Serology can help establish epidemiological link to COVID-19 when past infection or exposure are unknown.
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COVID-19 , COVID-19/complicaciones , COVID-19/epidemiología , Prueba de COVID-19 , Niño , Humanos , Los Angeles/epidemiología , Pandemias , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/epidemiologíaRESUMEN
BACKGROUND: In 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015. METHODS: Investigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples. RESULTS: Onsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer's updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera-containing aerosols into the operating room, despite hospital requests to the manufacturer. CONCLUSIONS: These findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer's protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.
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Infecciones por Mycobacterium no Tuberculosas , Infecciones por Mycobacterium , Humanos , Contaminación de Equipos , Kansas , Quimera , Infecciones por Mycobacterium/epidemiología , Infecciones por Mycobacterium/etiología , Complejo Mycobacterium avium , Aerosoles , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/etiología , Infecciones por Mycobacterium no Tuberculosas/prevención & controlRESUMEN
Southeast Asian ovalocytosis (SAO) is an erythrocyte abnormality that protects affected individuals from cerebral malaria. This trait is caused by a 27-bp deletion in the SLC4A1 gene, which is lethal when homozygous. We reseqeunced approximately 5 kb of SLC4A1 in an Indonesian population where SAO is prevalent to better understand the evolution of this clinically important trait. The four SAO chromosomes we resequenced share a single haplotype that differs from a sampled non-SAO haplotype only by the 27-bp deletion. Comparison of Indonesian sequence data to that from two other Asian populations (aboriginal Taiwanese and Japanese) shows Indonesian SLC4A1 to be strongly differentiated from the Taiwanese, but not the Japanese. Indeed, the Taiwanese sample contains only chromosomes that are highly divergent from all sampled SAO chromosomes. Because earlier studies have found an association between Austronesian-speakers (who most likely originated in Taiwan) and SAO, our failure to find SAO-like chromosomes in Taiwan is unexpected. Finally, our data find a strong excess of high-frequency derived alleles in all three populations. These alleles include the non-synonymous 'Memphis' variant, which is known to affect anion transport across the erythrocyte membrane. Our data suggest a role for recent natural selection acting on Memphis or a linked variant.