Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022.

As of November 14, 2022, monkeypox (mpox) cases had been reported from more than 110 countries, including 29,133 cases in the United States.* Among U.S. cases to date, 95% have occurred among males (1). After the first confirmed U.S. mpox case on May 17, 2022, limited supplies of JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) were made available to jurisdictions for persons exposed to mpox. JYNNEOS vaccine was approved by the Food and Drug Administration (FDA) in 2019 as a 2-dose series (0.5 mL per dose, administered subcutaneously) to prevent smallpox and mpox disease.† On August 9, 2022, FDA issued an emergency use authorization to allow administration of JYNNEOS vaccine by intradermal injection (0.1 mL per dose) (2). A previous report on U.S. mpox cases during July 31-September 3, 2022, suggested that 1 dose of vaccine offers some protection against mpox (3). This report describes demographic and clinical characteristics of cases occurring ≥14 days after receipt of 1 dose of JYNNEOS vaccine and compares them with characteristics of cases among unvaccinated persons with mpox and with the vaccine-eligible vaccinated population in participating jurisdictions. During May 22-September 3, 2022, among 14,504 mpox cases reported from 29 participating U.S. jurisdictions,§ 6,605 (45.5%) had available vaccination information and were included in the analysis. Among included cases, 276 (4.2%) were among persons who had received 1 dose of vaccine ≥14 days before illness onset. Mpox cases that occurred in these vaccinated persons were associated with lower percentage of hospitalization (2.1% versus 7.5%), fever, headache, malaise, myalgia, and chills, compared with cases in unvaccinated persons. Although 1 dose of JYNNEOS vaccine offers some protection from disease, mpox infection can occur after receipt of 1 dose, and the duration of protection conferred by 1 dose is unknown. Providers and public health officials should therefore encourage persons at risk for acquiring mpox to complete the 2-dose vaccination series and provide guidance and education regarding nonvaccine-related prevention strategies (4).

Improving the Food Environment in Washington State-Run Correctional Facilities: The Healthy Commissary Project.

Improvements to correctional facilities' food environment can provide healthier food and beverage options for incarcerated individuals, a population disproportionately affected by chronic disease. This article describes efforts to increase healthy options in the commissary program at Washington State correctional facilities from 2017 to 2019, and the role of a multidisciplinary collaboration between the state's Department of Corrections, Department of Health, and Statewide Family Council. Through the development, implementation, and promotion of nutrition standards, the nutritional quality of foods and beverages in the commissary program improved.

Qualitative Study on Participant Perceptions of a Supermarket Fruit and Vegetable Incentive Program.

BACKGROUND: Complete Eats Rx is a fruit and vegetable prescription program designed to incentivize fruit and vegetable consumption among Supplemental Nutrition Assistance Program (SNAP) participants via $10 incentives distributed either weekly or per encounter to purchase fruits and vegetables at a mid-price supermarket chain in Washington State. OBJECTIVE: To better understand SNAP participants' experience, and to determine perceived impacts and consequences of the program. DESIGN: Qualitative analysis of nine photovoice sessions. Participants chose the topics for discussion. Sessions were audiorecorded and transcribed. Thematic content analysis was performed to identify key emergent themes using Atlas.ti. SETTING: Spokane, Seattle, and Yakima, Washington. PARTICIPANTS: Twenty-six individuals who received a fruit and vegetable prescription within the past 6 months, 23 of whom attended all three photovoice sessions offered at their site. Participants were recruited from three participating health care or public health organizations in Spokane, Seattle, and Yakima, Washington. ANALYSIS: Transcriptions were coded using inductive methods. Coded statements were organized into major themes. Coding structures and analysis were strengthened by iterative interactions between researchers. RESULTS: Participants reported Complete Eats Rx was an important resource for families and improved food security, diet quality, and the ability to purchase healthy foods, including a greater variety of fruits and vegetables. Primary barriers to food security and fruit and vegetable consumption included limited geographic accessibility and the high cost of fruits and vegetables, exacerbated by other financial constraints such as rising housing costs. Participants reported supermarket checkout difficulty because of embarrassment, stigmatization, and inability to redeem incentives. The most frequently mentioned barrier to perceived program acceptability was having only one supermarket chain as the acceptor of the incentive. CONCLUSION: Partnering with supermarkets to accept fruit and vegetable incentives is a unique strategy to increase produce purchasing that can be adopted by other localities. Focus on geographic accessibility, appropriate price points, and positive shopping experiences via expansion to local grocers, improvements in staff interactions, and a transition to an electronic system may improve incentive redemption and usability.

Washington State's Fruit and Vegetable Prescription Program: Improving Affordability of Healthy Foods for Low-Income Patients.

PURPOSE AND OBJECTIVES: We conducted a mixed-methods process and outcome evaluation for a statewide fruit and vegetable prescription program. The process evaluation assessed program implementation, identified opportunities for quality improvement, and provided recommendations for future programmatic activities. The outcome evaluation measured how the program affected purchases of fruits and vegetables among low-income patients and patient satisfaction with the program. INTERVENTION APPROACH: The Washington State Department of Health (WA DOH) partnered with public and private health care systems, public health agencies, a community-based organization, and a supermarket chain to launch a fruit and vegetable prescription program in 2016. The prescription was a $10 voucher redeemable for fruits and vegetables at any one of 169 participating supermarkets. Prescriptions were distributed to eligible low-income patients in clinics and community settings. EVALUATION METHODS: WA DOH reviewed quarterly reports, meeting minutes and notes, telephone call logs, and email logs to solicit feedback on program implementation processes. We calculated overall prescription redemption rates on the basis of the number of prescriptions distributed by implementing partners and the number of prescriptions redeemed at participating supermarkets. We assessed patient satisfaction through a web-based survey. The study period was July 1, 2016, through June 30, 2018. RESULTS: Best practices for implementation included using the prescription to improve patient engagement and retention and connect patients to additional services, and working in the community to enhance program support and uptake. Overall, $154,810 in fruit and vegetable prescriptions were redeemed during the study period (54.4% redemption rate). Most survey respondents (88.2%) reported eating more fruits and vegetables than previously as a result of the prescription. IMPLICATIONS FOR PUBLIC HEALTH: Fruit and vegetable prescriptions are an effective way to increase affordability of healthy foods for low-income patients. These programs are scalable and translatable across various types of patient-provider encounters.

Relative Validity of Three Food Frequency Questionnaires for Assessing Dietary Intakes of Guatemalan Schoolchildren.

OBJECTIVE: To determine the relative validity of three food frequency questionnaires (FFQs) compared with results from 24-hour dietary recalls for measuring dietary intakes in Guatemalan schoolchildren. DESIGN: A cross-sectional study of primary caregivers (mothers or grandmothers) of 6-11 year-old children. Caregivers completed one of three constructed FFQs to measure the child's dietary consumption in the last week: FFQ1 did not incorporate portion sizes; FFQ2 provided portion sizes; and FFQ3 incorporated pictures of median portion sizes. During the same week, each caregiver also completed three 24-hour dietary recalls. Results from the FFQ were compared with corresponding results from the 24-hour dietary recalls. SETTING: Santa Catarina Pinula, peri-urban Guatemala City. SUBJECTS: Caregivers (n = 145) of 6-11 year-old children: 46 completed FFQ1, 49 completed FFQ2, and 50 completed FFQ3. RESULTS: The mean values for all nutrients obtained from the 24-hour dietary recall were lower than for those obtained from the FFQs, excluding folic acid in FFQ3, cholesterol and zinc in FFQ2, and cholesterol, folic acid, magnesium, potassium, sodium, and zinc in FFQ1. Energy-adjusted Pearson correlation coefficients ranged from 0.07 (protein) to 0.54 (cholesterol) for FFQ1 and from 0.05 to 0.74 for FFQ2 and FFQ3. Agreement by both methods (FFQ and 24-hour dietary recalls) of classifying children into the same or adjacent quartiles of energy-adjusted nutrient consumption ranged from 62.0% for cholesterol to 95.9% for vitamin B12 across all three FFQs. CONCLUSIONS: Our FFQs had moderate to good relative validity in measuring energy and nutrient intakes for 6-11 year-old Guatemalan children. More evidence is needed to evaluate their reproducibility and applicability in similar populations.

Diabetes and congenital heart defects: a systematic review, meta-analysis, and modeling project.

CONTEXT: Maternal pregestational diabetes (PGDM) is a risk factor for development of congenital heart defects (CHDs). Glycemic control before pregnancy reduces the risk of CHDs. A meta-analysis was used to estimate summary ORs and mathematical modeling was used to estimate population attributable fractions (PAFs) and the annual number of CHDs in the U.S. potentially preventable by establishing glycemic control before pregnancy. EVIDENCE ACQUISITION: A systematic search of the literature through December 2012 was conducted in 2012 and 2013. Case-control or cohort studies were included. Data were abstracted from 12 studies for a meta-analysis of all CHDs. EVIDENCE SYNTHESIS: Summary estimates of the association between PGDM and CHDs and 95% credible intervals (95% CrIs) were developed using Bayesian random-effects meta-analyses for all CHDs and specific CHD subtypes. Posterior estimates of this association were combined with estimates of CHD prevalence to produce estimates of PAFs and annual prevented cases. Ninety-five percent uncertainty intervals (95% UIs) for estimates of the annual number of preventable cases were developed using Monte Carlo simulation. Analyses were conducted in 2013. The summary OR estimate for the association between PGDM and CHDs was 3.8 (95% CrI=3.0, 4.9). Approximately 2670 (95% UI=1795, 3795) cases of CHDs could potentially be prevented annually if all women in the U.S. with PGDM achieved glycemic control before pregnancy. CONCLUSIONS: Estimates from this analysis suggest that preconception care of women with PGDM could have a measureable impact by reducing the number of infants born with CHDs.

Prevalence of undiagnosed diabetes among non-pregnant women of reproductive age in the United States, 1999-2010.

Undiagnosed diabetes has particularly harmful consequences among women of reproductive age. We assessed the prevalence of undiagnosed diabetes among non-pregnant women of reproductive age. In our data 30 women had A1C ≥ 6.5 and 28 had FPG ≥ 126 mg/dl values suggesting approximately 300,000 women of reproductive age nationwide may have undiagnosed diabetes.

Prepregnancy obesity and the risk of birth defects: an update.

The growing number of obese women worldwide has many implications for the reproductive health outcomes of mothers and their children. Specifically, prepregnancy obesity has been associated with certain major birth defects. Provided here is a summary of the most recent and comprehensive meta-analysis of reports of associations between prepregnancy obesity and birth defects, along with an update that includes a brief overview of reports of similar associations published since that meta-analysis. The possible reasons for the observed association between prepregnancy obesity and birth defects are explored, and knowledge gaps that suggest possible avenues for future research are highlighted.

Associations among dietary zinc intakes and biomarkers of zinc status before and after a zinc supplementation program in Guatemalan schoolchildren.

BACKGROUND: The associations among dietary zinc intakes and biomarkers of zinc status are unknown in apparently healthy children at high risk for zinc deficiency. OBJECTIVE: To assess associations among zinc-related parameters in a sample of Guatemalan school-aged children. METHODS: We assessed total dietary intakes and biomarkers of zinc status before and after receiving 6 months of zinc supplementation or placebo in 691 Guatemalan schoolchildren aged 6 to 11 years. Most of the children also received zinc-fortified milk from a government program that started shortly after the trial began. We assessed associations between zinc intakes and serum zinc, alkaline phosphatase (ALP), and albumin. RESULTS: At baseline, the prevalence of serum zinc < 65 microg/dL and dietary zinc intake below Estimated Average Requirements (EAR) (< 4 and < 7 mg/day for children < 9 and > or = 9 years, respectively) were 21.6% and 39.4%, respectively. Pearson correlations between serum zinc concentration and dietary zinc intake, serum ALP, and serum albumin were r = 0.07, 0.15, and 0.07, respectively. At the 6-month follow-up, low serum zinc and low total (diet plus fortified milk) zinc intakes were observed in 1.2% and 0.0% of children in the zinc-supplemented group and 4.0% and 34.1% in the placebo group, respectively. Pearson correlations between serum zinc concentration and total zinc intake, serum ALP, and serum albumin were 0.10, 0.06, and -0.11 in the zinc-supplemented group and -0.04, 0.05, and 0.01 in the placebo group, respectively. CONCLUSIONS: Zinc intake was inconsistently associated with markers of serum zinc concentration. Zinc fortification or supplementation attenuated the associations.

Race/ethnicity disparities in dysglycemia among U.S. women of childbearing age found mainly in the nonoverweight/nonobese.

OBJECTIVE: To describe the burden of dysglycemia-abnormal glucose metabolism indicative of diabetes or high risk for diabetes-among U.S. women of childbearing age, focusing on differences by race/ethnicity. RESEARCH DESIGN AND METHODS: Using U.S. National Health and Nutrition Examination Survey data (1999-2008), we calculated the burden of dysglycemia (i.e., prediabetes or diabetes from measures of fasting glucose, A1C, and self-report) in nonpregnant women of childbearing age (15-49 years) by race/ethnicity status. We estimated prevalence risk ratios (PRRs) for dysglycemia in subpopulations stratified by BMI (measured as kilograms divided by the square of height in meters), using predicted marginal estimates and adjusting for age, waist circumference, C-reactive protein, and socioeconomic factors. RESULTS: Based on data from 7,162 nonpregnant women, representing>59,000,000 women nationwide, 19% (95% CI 17.2-20.9) had some level of dysglycemia, with higher crude prevalence among non-Hispanic blacks and Mexican Americans vs. non-Hispanic whites (26.3% [95% CI 22.3-30.8] and 23.8% [19.5-28.7] vs. 16.8% [14.4-19.6], respectively). In women with BMI<25 kg/m2, dysglycemia prevalence was roughly twice as high in both non-Hispanic blacks and Mexican Americans vs. non-Hispanic whites. This relative increase persisted in adjusted models (PRRadj 1.86 [1.16-2.98] and 2.23 [1.38-3.60] for non-Hispanic blacks and Mexican Americans, respectively). For women with BMI 25-29.99 kg/m2, only non-Hispanic blacks showed increased prevalence vs. non-Hispanic whites (PRRadj 1.55 [1.03-2.34] and 1.28 [0.73-2.26] for non-Hispanic blacks and Mexican Americans, respectively). In women with BMI>30 kg/m2, there was no significant increase in prevalence of dysglycemia by race/ethnicity category. CONCLUSIONS: Our findings show that dysglycemia affects a significant portion of U.S. women of childbearing age and that disparities by race/ethnicity are most prominent in the nonoverweight/nonobese.

Effect of zinc on efficacy of iron supplementation in improving iron and zinc status in women.

Iron and zinc may interact in micronutrient supplements and thereby decrease efficacy. We investigated interactive effects of combined zinc and iron supplementation in a randomized controlled trial conducted in 459 Guatemalan women. Four groups were supplemented for 12 weeks: (1) weekly iron and folic acid (IFA); (2) weekly IFA and 30 mg zinc; (3) daily IFA; (4) daily IFA and 15 mg zinc. Effects were assessed by generalized linear regression. Baseline hemoglobin (Hb) concentration was 137.4 ± 15.5 g/L, 13% were anemic and 54% had zinc deficiency. Hb cconcentrations were similar by supplement type, but Hb concentrations improved significantly in anemic women at baseline (increase of 21.8 g/L). Mean percentage changes in serum ferritin were significantly higher in daily compared to weekly supplemented groups (86% versus 32%). The addition of zinc to IFA supplements had no significant impact on iron or zinc status. In conclusion, adding zinc to IFA supplements did not modify efficacy on iron status or improve zinc status, but daily supplementation was more efficacious than weekly in improving iron stores.

Gestational diabetes mellitus: taking it to heart.

Globally, cardiovascular disease (CVD) accounts for 1/3 of all deaths to women. While much research identifies the increased risk in CVD associated with pre-diabetes measurements, there is growing interest in the role of gestational diabetes mellitus (GDM)-a condition of glucose intolerance diagnosed during pregnancy-as a potential CVD risk factor. This article reviews existing evidence supporting this association, particularly regarding GDM and type 2 diabetes, hypertension, atherogenic dyslipedmia, and CVD events. Finally, it discusses the research and clinical ramifications of identifying GDM as a CVD risk factor, highlighting the need for more rigorous research on this topic.

Micronutrient supplementation may reduce symptoms of depression in Guatemalan women.

Evidence for the impact of micronutrient supplementation trials on depression in women from developing countries is limited. This study examines this association and compares the impact of weekly versus daily combinations of micronutrient supplements on symptoms of depression. A randomized, positive-controlled trial was conducted in Guatemala. A total of 459 women were assigned randomly to 4 groups to receive weekly (5,000 or 2,800 microg) or daily (400 or 200 microg) folic acid (FA) plus iron, zinc and vitamin B-12 for 12 weeks. Depression was measured using the Center for Epidemiologic Studies-Depression 20-item Scale (CES-D). A score = 16 was used as an indication of depression. The association between micronutrient status and depression was assessed using baseline data. Generalized linear regression models were used to assess treatment effects. The baseline mean CES-D score was 17.1 +/- 8.5 and the prevalence of depression was 49.3%. Women in the lowest tertile of red blood cell folate (RBC) were 1.7 times more likely to be depressed than those in the highest tertile (OR=1.71; 95% CI: 0.91, 3.18). There were no associations between depression and serum folate, homocysteine, vitamin B-12, hemoglobin, ferritin or zinc (p > 0.05). Mean depression scores decreased by 2.3 points post-intervention and depression decreased to 37.7%, with no differences in degree of improvement by group (p = 0.64). Low RBC folate was associated with elevated symptoms of depression at baseline. Supplementation with FA-containing micronutrients may be equally efficacious in improving symptoms of depression when provided daily or weekly. Our findings that poor folate status may increase depression needs to be further investigated.

Micronutrient supplementation may reduce symptoms of depression in Guatemalan women / Potencial reducción de síntomas de depresión en mujeres en Guatemala mediante la suplementación con micronutrientes

Evidence for the impact of micronutrient supplementation trials on depression in women from developing countries is limited. This study examines this association and compares the impact of weekly versus daily combinations of micronutrient supplements on symptoms of depression. A randomized, positive-controlled trial was conducted in Guatemala. A total of 459 women were assigned randomly to 4 groups to receive weekly (5,000 or 2,800µg) or daily (400 or 200 µg) folic acid (FA) plus iron, zinc and vitamin B-12 for 12 weeks. Depression was measured using the Center for Epidemiologic Studies-Depression 20-item Scale (CES-D). A score=16 was used as an indication of depression. The association between micronutrient status and depression was assessed using baseline data. Generalized linear regression models were used to assess treatment effects. The baseline mean CES-D score was 17.1±8.5 and the prevalence of depression was 49.3 percent. Women in the lowest tertile of red blood cell folate (RBC) were 1.7 times more likely to be depressed than those in the highest tertile (OR=1.71; 95 percent CI: 0.91, 3.18). There were no associations between depression and serum folate, homocysteine, vitamin B-12, hemoglobin, ferritin or zinc (p > 0.05). Mean depression scores decreased by 2.3 points post-intervention and depression decreased to 37.7 percent, with no differences in degree of improvement by group (p = 0.64). Low RBC folate was associated with elevated symptoms of depression at baseline. Supplementation with FA-containing micronutrients may be equally efficacious in improving symptoms of depression when provided daily or weekly. Our findings that poor folate status may increase depression needs to be further investigated.

La evidencia del impacto de ensayos de suplementación con micronutrientes en mujeres con depresión en países en desarrollo es limitada. El presente estudio examina esta asociación y compara el impacto de varias combinaciones de micronutrientes proporcionadas de manera semanal o diaria en los síntomas de depresión, utilizando datos de un ensayo controlado (control positivo) y aleatorizado realizado en Guatemala. Un total de 459 mujeres fueron asignadas al azar entre cuatro grupos para recibir semanalmente (5.000 o 2.800 µg) o diariamente (400 o 200 µg) de ácido fólico (AF) combinado con hierro, cinc y vitamina B-12 durante 12 semanas. La depresión fue medida utilizando la escala de 20 ítems del Centro de Estudios Epidemiológicos de la Depresión (CES-D). Un puntaje =16 fue considerado indicativo de depresión. Se evaluó la asociación entre el nivel de micronutrientes en sangre y depresión utilizando datos provistos por la línea de base. Se utilizaron modelos de Regresión Linear Generalizada para evaluar los efectos del tratamiento. La media del puntaje de la línea de base CES-D fue de 17,1±8,5 y la prevalencia de depresión fue del 49,3 por ciento. Las mujeres en el tercil más bajo del folato eritrocitario presentaron 1,7 veces más probabilidades de estar deprimidas que aquellas en el tercil más alto (OR=1,71; 95 por ciento CI: 0,91, 3,18). No se encontró asociación entre depresión y folato sérico, homocisteína, vitamina B-12, hemoglobina, ferritina sérica o cinc (p>0,05). Los puntajes de depresión medios post-intervención disminuyeron en 2.3 puntos y la depresión se redujo a 37,7 por ciento, sin presentar diferencias en el grado de mejoría por grupo (p=0,64). En síntesis, el bajo nivel de folato eritrocitario se asoció a síntomas elevados depresivos en la línea de base. La suplementación con AF sumado a otros micronutrientes puede ser igualmente eficaz en la mejora de síntomas depresivos cuando provista diaria o semanalmente...

Weekly may be as efficacious as daily folic acid supplementation in improving folate status and lowering serum homocysteine concentrations in Guatemalan women.

Daily folic acid (FA) supplementation improves folate status, lowers circulating homocysteine (Hcy) concentrations, and reduces the risk of neural tube defects. Little is known about the efficacy of weekly FA supplementation. The objective of this study was to compare the efficacy of weekly and daily FA supplementations in improving folate and vitamin B-12 status and lowering Hcy concentrations in healthy reproductive-aged women. A randomized, double-blind supplementation trial was conducted in Guatemala. A total of 459 women were assigned randomly to 4 groups to receive weekly (5000 or 2800 microg) or daily (400 or 200 microg) FA for 12 wk. Daily and weekly iron, zinc, and vitamin B-12 were also provided. We determined serum and RBC folate by microbiological assays, but the latter was available only at baseline. Serum Hcy and vitamin B-12 were also measured. We used generalized linear regression models to assess the effects of treatment on biochemical indicators. Supplementation improved folate status similarly across all 4 groups. Overall, mean serum folate concentrations increased by 15.4 nmol/L (95% CI: 13.8, 16.9) and the geometric mean serum Hcy concentration decreased by 9.8% (95% CI: -12.3, -7.1). Daily supplementation improved serum vitamin B-12 by 20% (95% CI: 8, 33.2), whereas weekly supplementation had no effect. In conclusion, weekly FA (either high or low dose) plus vitamin B-12 may be as efficacious as daily supplementation in improving serum folate and lowering Hcy concentrations in healthy women of reproductive age.