Cross-sectional survey of SARS-CoV-2 testing at US airports and one health department's proactive management of travelers.

BACKGROUND: Many health departments and private enterprises began offering SARS-CoV-2 testing to travelers at US airports in 2020. Persons with positive SARS-CoV-2 test results who have planned upcoming travel may be subject to US federal public health travel restrictions. We assessed availability of testing for SARS-CoV-2 at major US airports. We then describe the management of cases and close contacts at Denver International Airport's testing site. METHODS: We selected 100 US airports. Online surveys were conducted during November-December 2020 and assessed availability of testing for air travelers, flight crew, and airport employees. Respondents included health department (HD) staff or airport directors. We analyzed testing data and management practices for persons who tested positive and their close contacts at one airport (Denver International) from 12/21/2020 to 3/31/2021. RESULTS: Among the 100 selected airports, we received information on 77 airports; 38 (49%) had a testing site and several more planned to offer one (N = 7; 9%). Most sites began testing in the fall of 2020. The most frequently offered tests were RT-PCR or other NAAT tests (N = 28). Denver International Airport offered voluntary SARS-CoV-2 testing. Fifty-four people had positive results among 5724 tests conducted from 12/21/2020 to 3/31/2021 for a total positivity of < 1%. Of these, 15 were travelers with imminent flights. The Denver HD issued an order requiring the testing site to immediately report cases and notify airlines to cancel upcoming flight itineraries for infected travelers and their traveling close contacts, minimizing the use of federal travel restrictions. CONCLUSIONS: As of December 2020, nearly half of surveyed US airports had SARS-CoV-2 testing sites. Such large-scale adoption of airport testing for a communicable disease is unprecedented and presents new challenges for travelers, airlines, airports, and public health authorities. This assessment was completed before the US and other countries began enforcing entry testing requirements; testing at airports will likely increase as travel demand returns and test requirements for travel evolve. Lessons from Denver demonstrate how HDs can play a key role in engaging airport testing sites to ensure people who test positive for SARS-CoV-2 immediately before travel do not travel on commercial aircraft.

Estimating the frequency and characteristics of respiratory disease outbreaks at mass gatherings in the United States: Findings from a state and local health department assessment.

Mass gatherings create environments conducive to the transmission of infectious diseases. Thousands of mass gatherings are held annually in the United States; however, information on the frequency and characteristics of respiratory disease outbreaks and on the use of nonpharmaceutical interventions at these gatherings is scarce. We administered an online assessment to the 50 state health departments and 31 large local health departments in the United States to gather information about mass gathering-related respiratory disease outbreaks occurring between 2009 and 2014. The assessment also captured information on the use of nonpharmaceutical interventions to slow disease transmission in these settings. We downloaded respondent data into a SAS dataset for descriptive analyses. We received responses from 43 (53%) of the 81 health jurisdictions. Among these, 8 reported 18 mass gathering outbreaks. More than half (n = 11) of the outbreaks involved zoonotic transmission of influenza A (H3N2v) at county and state fairs. Other outbreaks occurred at camps (influenza A (H1N1)pdm09 [n = 2] and A (H3) [n = 1]), religious gatherings (influenza A (H1N1)pdm09 [n = 1] and unspecified respiratory virus [n = 1]), at a conference (influenza A (H1N1)pdm09), and a sporting event (influenza A). Outbreaks ranged from 5 to 150 reported cases. Of the 43 respondents, 9 jurisdictions used nonpharmaceutical interventions to slow or prevent disease transmission. Although respiratory disease outbreaks with a large number of cases occur at many types of mass gatherings, our assessment suggests that such outbreaks may be uncommon, even during the 2009 influenza A (H1N1) pandemic, which partially explains the reported, but limited, use of nonpharmaceutical interventions. More research on the characteristics of mass gatherings with respiratory disease outbreaks and effectiveness of nonpharmaceutical interventions would likely be beneficial for decision makers at state and local health departments when responding to future outbreaks and pandemics.

CDC-funded HIV testing, HIV positivity, and linkage to HIV medical care in non-health care settings among young men who have sex with men (YMSM) in the United States.

In the United States, HIV infection disproportionately affects young gay, bisexual, and other men who have sex with men, aged 13-24 years (collectively referred to as YMSM), specifically black YMSM. Knowledge of HIV status is the first step for timely and essential prevention and treatment services. Because YMSM are disproportionately affected by HIV, the number of CDC-funded HIV testing events, overall and newly diagnosed HIV positivity, and linkage to HIV medical care among YMSM in non-health care settings were examined from 61 health department jurisdictions. Differences by age and race/ethnicity were analyzed. Additionally, trends in number of HIV testing events and newly diagnosed HIV positivity were examined from 2011 to 2015. In 2015, 42,184 testing events were conducted among YMSM in non-health care settings; this represents only 6% of tests in non-health care settings. Overall and newly diagnosed HIV positivity was 2.8% and 2.1%, respectively, with black/African-American YMSM being disproportionately affected (5.6% for overall; 4% for newly diagnosed); 71% of YMSM were linked within 90 days. The newly diagnosed HIV positivity among YMSM decreased from 2.8% in 2011 to 2.4% in 2015, and the number of newly diagnosed YMSM also decreased. Further targeted testing efforts among YMSM are needed to identify undiagnosed YMSM, specifically black YMSM.

Centers for Disease Control and Prevention-Funded Human Immunodeficiency Virus Testing, Positivity, and Service Delivery among Newly Diagnosed Women in 61 Health Department Jurisdictions, United States, 2014.

BACKGROUND: More than 1.2 million persons are living with human immunodeficiency virus (HIV) in the United States; at the end of 2011, 23% of them were women. Minority women are disproportionately affected by HIV, and new infections are higher among older women. HIV testing and service delivery among women funded by the U.S. Centers for Disease Control and Prevention (CDC) is examined. METHODS: Data were submitted by 61 health department jurisdictions. HIV testing, HIV-positive tests, new HIV diagnoses among women, and linkage and referral services among newly diagnosed women are described. Differences across demographic characteristics for HIV diagnoses, linkage, and referral services were assessed. Diagnoses were identified as new when women who tested HIV positive were not found to be reported previously in the jurisdiction's HIV surveillance system; when jurisdictions could not verify prior test results in their surveillance systems, new diagnoses were identified by self-report. RESULTS: Of CDC-funded testing events in 2014, 1,484,902 (48.7%) were among women, and they accounted for 19.5% of all HIV-positive testing events. Among women tested, 0.4% were HIV positive, and 0.1% had new HIV diagnoses. Women aged 40 and older and Black women were more likely to test HIV positive (0.7% and 0.5%, respectively). Among newly diagnosed women, 62.8% were linked within any timeframe, 57.1% were linked within 90 days, 74.1% were referred to partner services, 57.5% were interviewed for partner services, and 55.5% were referred to HIV risk reduction services. CONCLUSIONS: Among all women receiving CDC-funded HIV testing, Black women and older women were more likely to have HIV-positive tests and new diagnoses. Although women overall may not be at the highest risk for HIV, Black women in this sample are disproportionately affected. Additionally, linkage, referral, and interview services for women need improvement. Targeted testing approaches may ensure effective test-and-treat strategies for women.

HIV Testing, HIV Positivity, and Linkage and Referral Services in Correctional Facilities in the United States, 2009-2013.

BACKGROUND: Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)-funded HIV testing and service delivery in correctional facilities. METHODS: Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. RESULTS: Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. CONCLUSIONS: Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease.

HIV testing and service delivery among Blacks or African Americans--61 health department jurisdictions, United States, 2013.

In the United States, approximately 1.2 million persons are living with human immunodeficiency virus (HIV), of whom approximately 14.0% have not received a diagnosis. Some groups are disproportionately affected by HIV, such as persons who self-identify as blacks or African Americans (in this report referred to as blacks). Blacks accounted for 12.0% of the United States' population but accounted for 41.0% of persons living with HIV in 2011. HIV testing is critical to identify those who are infected and link them to HIV medical care for their own health and to reduce transmission to partners. To assess progress toward increasing HIV testing and service delivery among blacks in 2013, CDC analyzed national-level program data submitted by 61 health departments and 151 directly funded community-based organizations through the National HIV Prevention Program Monitoring and Evaluation system. This report describes the results of that analysis, which found that, in 2013, blacks accounted for 45.0% of CDC-funded HIV testing events (TEs) and more than half (54.9%) of all newly identified HIV-positive persons (in this report referred to as new positives). Among blacks, gay, bisexual, and other men who have sex with men (collectively referred to as MSM) had the highest percentage of new positives (9.6%). Broader implementation of routine HIV screening and HIV testing targeted towards populations at high risk can help identify persons with undiagnosed HIV infection and link these persons to HIV medical care and prevention services. Linkage to medical care and referrals to HIV partner services and HIV prevention services among blacks could be improved.