Modeling platform to assess the effectiveness of single and integrated Ixodes scapularis tick control methods.

BACKGROUND: Lyme disease continues to expand in Canada and the USA and no single intervention is likely to curb the epidemic. METHODS: We propose a platform to quantitatively assess the effectiveness of a subset of Ixodes scapularis tick management approaches. The platform allows us to assess the impact of different control treatments, conducted either individually (single interventions) or in combination (combined efforts), with varying timings and durations. Interventions include three low environmental toxicity measures in differing combinations, namely reductions in white-tailed deer (Odocoileus virginianus) populations, broadcast area-application of the entomopathogenic fungus Metarhizium anisopliae, and fipronil-based rodent-targeted bait boxes. To assess the impact of these control efforts, we calibrated a process-based mathematical model to data collected from residential properties in the town of Redding, southwestern Connecticut, where an integrated tick management program to reduce I.xodes scapularis nymphs was conducted from 2013 through 2016. We estimated parameters mechanistically for each of the three treatments, simulated multiple combinations and timings of interventions, and computed the resulting percent reduction of the nymphal peak and of the area under the phenology curve. RESULTS: Simulation outputs suggest that the three-treatment combination and the bait boxes-deer reduction combination had the overall highest impacts on suppressing I. scapularis nymphs. All (single or combined) interventions were more efficacious when implemented for a higher number of years. When implemented for at least 4 years, most interventions (except the single application of the entomopathogenic fungus) were predicted to strongly reduce the nymphal peak compared with the no intervention scenario. Finally, we determined the optimal period to apply the entomopathogenic fungus in residential yards, depending on the number of applications. CONCLUSIONS: Computer simulation is a powerful tool to identify the optimal deployment of individual and combined tick management approaches, which can synergistically contribute to short-to-long-term, costeffective, and sustainable control of tick-borne diseases in integrated tick management (ITM) interventions.

Successful practices to reduce central line-associated bloodstream infections post pandemic: A qualitative study.

BACKGROUND: Central Line-Associated Bloodstream Infections (CLABSIs) decreased in U.S. hospitals over the last decade, but CLABSI rates increased during the COVID-19 pandemic disrupting the downward trend. This study explored factors contributing to the reduction of CLABSI, identifying deviations in infection prevention and control protocol during the pandemic, actions taken to address the increase in CLABSI, and factors promoting sustained progress. METHODS: This qualitative study used the National Healthcare Safety Network data. The Centers for Disease Control and Prevention identified hospitals with elevated CLABSI standardized infection ratios (SIR) >1 between Q1 2019 - Q4 2021 followed by four quarters of sustained reduction (CLABSI SIR <1). Joint Commission researchers conducted semi-structured phone interviews with infection preventionist professionals from six hospitals representing these performance patterns. RESULTS: Interview themes suggested that staffing shortages (83%) and less vigilant central line practices (100%) contributed to increased CLABSI SIR during the pandemic. Organizations described evidence-based interventions, such as using chlorhexidine gluconate for skin preparation, along with other innovative strategies they used to establish reduced CLABSI rates. CONCLUSIONS: Despite challenges faced during the COVID-19 pandemic, some health care organizations have excelled in their efforts to reduce and sustain low rates of CLABSI by implementing evidence-based practices, innovative solutions, and education.

Late fall synthetic acaricide application is effective at reducing host-seeking adult and nymphal Ixodes scapularis (Ixodida: Ixodidae) abundances the following spring.

Based on increases in reported cases of tick-borne illnesses, expanding ranges of native ticks, and repeated documentation of arrivals of nonnative tick species, there is a clear need for their effective management in the United States. Synthetic acaricides have proven efficacious in tick management, but real/perceived negative impacts to the environment and nontarget, beneficial insects must be addressed. We sought to determine whether late fall synthetic acaricide application, when most susceptible beneficial insects are presumably dormant or have migrated, could effectively manage host-seeking spring Ixodes scapularis Say abundances as compared to traditional spring application. We compared results of delivery of Demand CS (lambda-cyhalothrin) via truck-mounted high-pressure spray and powered backpack blower as well as delivery of granular Demand G to experimental control (water) in peridomestic habitats in fall 2021, spring 2022, and combined fall 2021/spring 2022. High-pressure fall delivery of Demand CS and backpack delivery of Demand G significantly reduced host-seeking adult I. scapularis abundances within-season and the following spring combined by 100% and 94%, respectively. No host-seeking nymphal I. scapularis were documented in spring after fall only, spring only, or fall and spring combined delivery of Demand CS via high-pressure or powered backpack blower. No adult I. scapularis were documented at any time posttreatment on locations that received high-pressure delivery of Demand CS. We conclude that high-pressure delivery of Demand CS in late fall successfully eliminated multiple stages of host-seeking I. scapularis through the following spring while likely limiting exposure of beneficial insects to synthetic pyrethroids.

Infection Control Measure Performance in Long-Term Care Hospitals and Their Relationship to Joint Commission Accreditation.

BACKGROUND: This study evaluated the relationship between Joint Commission accreditation and health care-associated infections (HAIs) in long-term care hospitals (LTCHs). METHODS: This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line-associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic. RESULTS: The data set included 244 (73.3%) Joint Commission-accredited and 89 (26.7%) non-Joint Commission-accredited LTCHs. Compared to non-Joint Commission-accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission-accredited LTCHs performed significantly better than the national benchmark for all three measures (p = 0.04 for CAUTI, p = 0.02 for CDI, p = 0.01 for CLABSI). CONCLUSION: Although this study was not designed to establish causality, positive associations were observed between Joint Commission accreditation and CLABSI and CAUTI measures, and Joint Commission-accredited LTCHs attained more consistent high performance over the four-year study period for all three measures. Influencing factors may include the focus of Joint Commission standards on infection control and prevention (ICP), including the hierarchical approach to selecting ICP-related standards as inputs into LTCH policy.

Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge.

BACKGROUND: The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown. METHODS: This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission-accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention. RESULTS: Of 1,148 hospitals, 346 (30.1%) responded. The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge. CONCLUSION: The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.

Evaluation of landscaping and vegetation management to suppress host-seeking Ixodes scapularis (Ixodida: Ixodidae) nymphs on residential properties in Connecticut, USA.

Ticks and tick-borne diseases are of increasing concern across the United States, particularly in the Northeast. Ixodes scapularis Say (Ixodida: Ixodidae) remains the primary vector for the Lyme disease spirochete, Borrelia burgdorferi (Johnson, Schmid, Hyde, Steigerwalt, and Brenner). Prior studies established that I. scapularis can be found in greatest abundance in the 1-m forested ecotone surrounding the lawn edge in residential backyards. Our study was conducted on 42 properties in Guilford, CT, and sought to expand upon this premise by determining which key habitat features were associated with increased densities of host-seeking I. scapularis nymphs. We quantified nymphal abundances in 19 different habitat types that were posited to influence densities. We determined that nymphal I. scapularis densities were greatest in forested areas closest to lawn edges with leaf litter or understory vegetation present, as well as short lawns adjacent to woodland edges. Additionally, we determined that there were no significant declines in nymphal I. scapularis density where leaf litter was removed, lawns were left unmowed, or woodchip barriers were installed. Bird feeders and woodpiles were not associated with increased nymphal I. scapularis densities. However, areas adjacent to stone walls did have nearly 3 times the density of I. scapularis nymphs present compared with habitats without stone walls. The culmination of the results from this study can be utilized to create more targeted acaricide applications rather than broadcast spraying, as well as increase homeowner awareness for areas with heightened risk for exposure to nymphal I. scapularis, which are deemed the most epidemiologically important species and stage for pathogen transfer to humans.

Introduction of the ectoparasite Rhipicephalus pulchellus (Ixodida: Ixodidae) into Connecticut with a human traveler from Tanzania, and a review of its importation records into the United States.

Globalization, increased frequency of travel, and a rise in legal and illegal animal trades can introduce exotic ticks into the United States. We herein report the importation of a male Rhipicephalus pulchellus (Gerstäcker) on a human traveler returning to Connecticut from Tanzania, Africa, and review historical importation records of this species into the United States. This common tick is broadly distributed throughout East Africa, from Eritrea to Tanzania, has a wide host range on domestic animals and wildlife, and has been most frequently introduced into the United States on tick-infested wild animal hosts and animal trophies, but documentation of importation on humans has been rare. Archival records at the United States Department of Agriculture's National Veterinary Services Laboratories show R. pulchellus has been introduced into the United States at least 40 times over the last 62 yr. Rhipicephalus pulchellus has been linked to Rickettsia conorii, the agent of boutonneuse fever in humans, Crimean-Congo hemorrhagic fever orthonairovirus, and Nairobi sheep disease orthonairovirus. Given the potential for this exotic tick to introduce animal or human pathogens, proper surveillance, interception, identification, and reporting of these ticks are vital in protecting human and animal health.

Survey of white-footed mice in Connecticut, USA reveals low SARS-CoV-2 seroprevalence and infection with divergent betacoronaviruses.

Diverse mammalian species display susceptibility to and infection with SARS-CoV-2. Potential SARS-CoV-2 spillback into rodents is understudied despite their host role for numerous zoonoses and human proximity. We assessed exposure and infection among white-footed mice (Peromyscus leucopus) in Connecticut, USA. We observed 1% (6/540) wild-type neutralizing antibody seroprevalence among 2020-2022 residential mice with no cross-neutralization of variants. We detected no SARS-CoV-2 infections via RT-qPCR, but identified non-SARS-CoV-2 betacoronavirus infections via pan-coronavirus PCR among 1% (5/468) of residential mice. Sequencing revealed two divergent betacoronaviruses, preliminarily named Peromyscus coronavirus-1 and -2. Both belong to the Betacoronavirus 1 species and are ~90% identical to the closest known relative, Porcine hemagglutinating encephalomyelitis virus. Low SARS-CoV-2 seroprevalence suggests white-footed mice may not be sufficiently susceptible or exposed to SARS-CoV-2 to present a long-term human health risk. However, the discovery of divergent, non-SARS-CoV-2 betacoronaviruses expands the diversity of known rodent coronaviruses and further investigation is required to understand their transmission extent.

Comparison of acarological risk metrics derived from active and passive surveillance and their concordance with tick-borne disease incidence.

Tick-borne diseases continue to threaten human health across the United States. Both active and passive tick surveillance can complement human case surveillance, providing spatio-temporal information on when and where humans are at risk for encounters with ticks and tick-borne pathogens. However, little work has been done to assess the concordance of the acarological risk metrics from each surveillance method. We used data on Ixodes scapularis and its associated human pathogens from Connecticut (2019-2021) collected through active collections (drag sampling) or passive submissions from the public to compare county estimates of tick and pathogen presence, infection prevalence, and tick abundance by life stage. Between the surveillance strategies, we found complete agreement in estimates of tick and pathogen presence, high concordance in infection prevalence estimates for Anaplasma phagocytophilum, Borrelia burgdorferi sensu stricto, and Babesia microti, but no consistent relationships between actively and passively derived estimates of tick abundance or abundance of infected ticks by life stage. We also compared nymphal metrics (i.e., pathogen prevalence in nymphs, nymphal abundance, and abundance of infected nymphs) with reported incidence of Lyme disease, anaplasmosis, and babesiosis, but did not find any consistent relationships with any of these metrics. The small spatial and temporal scale for which we had consistently collected active and passive data limited our ability to find significant relationships. Findings are likely to differ if examined across a broader spatial or temporal coverage with greater variation in acarological and epidemiological outcomes. Our results indicate similar outcomes between some actively and passively derived tick surveillance metrics (tick and pathogen presence, pathogen prevalence), but comparisons were variable for abundance estimates.

Experimental oral delivery of the systemic acaricide moxidectin to free-ranging white-tailed deer (Artiodactyla: Cervidae) parasitized by Amblyomma americanum (Ixodida: Ixodidae).

Orally delivered, host-targeted, systemic acaricide treatment has potential to be an effective areawide tick abatement strategy. Past efforts using ivermectin for livestock were reported effective at controlling both Amblyomma americanum (L.) and Ixodes scapularis Say on Odocoileus virginianus (Zimmermann). However, the labeled 48-day withdrawal period for human consumption largely prevented utilization of this strategy targeting I. scapularis in autumn, when peak adult host-seeking activity coincides with regulated white-tailed deer hunting seasons. The modern-day compound moxidectin is the active ingredient in the pour-on formulation Cydectin (5 mg moxidectin/ml; Bayer Healthcare LLC), with a labeled 0-day withdrawal period for human consumption of treated cattle. We sought to re-examine the systemic acaricide approach for tick management by determining if we could successfully deliver Cydectin to free-ranging white-tailed deer. Over 2 yr in late spring/early summer, coinciding with adult and nymphal A. americanum activity, we fed Cydectin-coated corn to free-ranging white-tailed deer in coastal Connecticut. Through serum analysis, we documented moxidectin levels at or above those previously reported effective for control of ectoparasites (5-8 ppb for moxidectin and ivermectin) in 24 of 29 white-tailed deer captured (83%) while exposed to treated corn. While we did not document differences in burdens of parasitizing A. americanum based on moxidectin sera levels, we did document fewer engorged specimens on deer with increased sera levels. The systemic use of moxidectin for tick management in critical reproductive hosts has the potential to be effective in an areawide capacity while also permitting human consumption of treated venison.

Clinician Well-Being Assessment and Interventions in Joint Commission-Accredited Hospitals and Federally Qualified Health Centers.

BACKGROUND: Clinician burnout is a longstanding national problem threatening clinician health, patient outcomes, and the health care system. The aim of this study is to determine the proportion of hospitals and Federally Qualified Health Centers (FQHCs) that are measuring and taking system actions to promote clinician well-being. METHODS: This cross-sectional study used an electronic questionnaire from April 21 to June 27, 2022, to assess the current state of organizational efforts to assess and address clinician well-being among a national sample of 1,982 Joint Commission-accredited hospitals and 256 accredited FQHCs. Outcomes of interest included the proportion of hospitals and FQHCs that assessed the prevalence of clinician burnout, established a chief wellness officer position, established a wellness committee, made clinician well-being an organizational performance metric, and implemented other activities/interventions that target clinician burnout. RESULTS: A total of 481 (21.5%) organizations responded to the survey (hospital n = 396 [20.0%], FQHC n = 85 [33.2%]). Response rates did not differ by organization size, type, teaching status or urban vs. rural location. Approximately one third (34.0%) of the organizations in the sample conducted an organizational well-being assessment among clinicians at least once in the past three years. Although nearly half of responding organizations reported implementing some kind of intervention to address clinician burnout, only 28.7% of organizations had adopted a comprehensive approach to address clinician well-being/burnout. Only 10.1% of hospitals and 5.4% of FQHCs reported having an established senior leadership position responsible for assessing and promoting clinician well-being at the organization level, and less than half (29.3% FQHCs, 37.6% hospitals) of organizations reported having an established wellness committee. Among 500+ bed hospitals, 61.2% had surveyed, 75.6% had established a well-being committee, 78.0% had implemented interventions to promote clinician well-being, and 26.8% had established a chief wellness officer. CONCLUSION: Although half of Joint Commission-accredited hospitals and FQHCs reported taking steps to improve clinician well-being, a minority are measuring clinician well-being, and few are taking a comprehensive approach or established a chief wellness officer position to advance clinician well-being as an organizational priority. Organizational clinician well-being improvement efforts are unlikely to be successful without measurement and leadership in place to drive change.

Orally delivered fipronil-laced bait reduces juvenile blacklegged tick (Ixodes scapularis) burdens on wild white-footed mice (Peromyscus leucopus).

While the topical acaricidal treatment of rodent pathogen reservoirs has been readily explored over the past several decades, oral systemic acaricidal treatment is only recently gaining traction as an alternative approach to the management of ticks and tick-borne pathogens. Recent laboratory tests have shown promise in the effectiveness of this systemic strategy against the blacklegged tick (Ixodes scapularis) and a Canadian field evaluation was recently published, but no recent field data from the United States yet exist. With this research, we sought to field deploy a commercially available fipronil-laced bait (Kaput® Flea Control Bait, Scimetrics LLC., Wellington, CO, USA; 0.005% fipronil; Environmental Protection Agency Reg. No. 72500-28), in an alternate use targeting white-footed mice (Peromyscus leucopus) to determine bait acceptance and potential impacts to juvenile I. scapularis burdens. Bait was readily accepted by wild P. leucopus and other rodent reservoirs. An ad libitum distribution strategy as well as placing smaller volumes of fipronil-laced bait within individual Sherman traps both resulted in significant reductions (57-94%) in juvenile I. scapularis burdens as compared to control over two years. The oral delivery of systemic acaricides shows promise in reduction of I. scapularis burdens on P. leucopus and should be further explored to determine effectiveness on host-seeking tick abundances, associated pathogen infection, and potentially incorporated into integrated tick management programs.

Home Health Agency Patient Experience Measures and Their Relationship to Joint Commission Accreditation.

BACKGROUND: Health care accreditation is a widely accepted mechanism for improving the quality of care and promoting patient safety. An integral dimension of health care quality is the patient experience of care. However, the influence of accreditation on the patient experience is unclear. The Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey is the standard for collecting patient care experience data in the home health setting. The aim of this study was to examine the association of Joint Commission accreditation on patients' experience of care by comparing HHCAHPS ratings from Joint Commission-accredited and non-Joint Commission-accredited home health agencies (HHAs). METHODS: This multiyear observational study used 2015-2019 HHCAHPS data obtained from the Centers for Medicare & Medicaid Services (CMS) website and Joint Commission databases. The data set included 1,454 (23.8%) Joint Commission-accredited and 4,643 (76.2%) non-Joint Commission-accredited HHAs. Dependent variables included three composite measures of care (Care of Patients, Provider-Patient Communications, and Specific Care Issues) and two global rating measures. Data were analyzed using a series of longitudinal random effects logistic regression models. RESULTS: This study found no association between Joint Commission accreditation and the two global HHCAHPS measures, modest significant increases for Joint Commission-accredited HHAs in measure rates for the Care of Patients and Communication composite measures (p < 0.05), and a more significant increase for the Specific Care Issues composite measure related to medication safety and home safety (p < 0.001). CONCLUSIONS: These findings suggest that Joint Commission accreditation may be positively associated with some patient experience of care outcomes. This relationship was most pronounced when there was significant overlap between the focus of the accreditation standards and focus of the HHCAHPS items.

Phylogeographic reconstruction of the emergence and spread of Powassan virus in the northeastern United States.

Powassan virus is an emerging tick-borne virus of concern for public health, but very little is known about its transmission patterns and ecology. Here, we expanded the genomic dataset by sequencing 279 Powassan viruses isolated from Ixodes scapularis ticks from the northeastern United States. Our phylogeographic reconstructions revealed that Powassan virus lineage II was likely introduced or emerged from a relict population in the Northeast between 1940 and 1975. Sequences strongly clustered by sampling location, suggesting a highly focal geographical distribution. Our analyses further indicated that Powassan virus lineage II emerged in the northeastern United States mostly following a south-to-north pattern, with a weighted lineage dispersal velocity of ~3 km/y. Since the emergence in the Northeast, we found an overall increase in the effective population size of Powassan virus lineage II, but with growth stagnating during recent years. The cascading effect of population expansion of white-tailed deer and I. scapularis populations likely facilitated the emergence of Powassan virus in the northeastern United States.

The Effects of Photobiomodulation Therapy on Porcine Islet Insulin Secretion.

Background and objective: Xenotransplantation of porcine islets to human recipients has been investigated as a potential cure for type 1 diabetes. However, the porcine islets have poor insulin secretion capacity compared with human islets. The objective of this study was to evaluate the effect of photobiomodulation therapy (PBMT) in insulin secretion on isolated porcine islets. Methods: Eight pancreata were harvested from crossbred market porcine and the islets were isolated from the pancreas. The isolated islets were treated with PBMT (wavelength: 633 nm and dosages: 0.0, 15.6, and 31.3 J/cm2) followed by 30-min incubation in low (3.0 mM) or high (16.7 mM) glucose. The relative percentage differences on insulin secretion between three dosages were compared in low and high glucose, respectively. Results: Insulin secretion was higher in samples exposed to 15.6 J/cm2 PBMT in low glucose (p < 0.05), but not in high glucose. When evaluating sex differences, male islets had higher insulin secretion by 15.6 J/cm2 PBMT in low glucose compared with females (p < 0.05). No significant differences were seen in high glucose. When compared within the control groups (0.0 J/cm2 PBMT), the relative changes on insulin secretion in high glucose was significantly higher on male islets (p < 0.05), but not on female islets. Conclusions: PBMT may increase insulin secretion on isolated porcine islets in basal condition, but it may not improve islets' glucose responsiveness to secrete insulin. Male porcine islets may respond to PBMT and glucose stimuli better than female islets on insulin secretion.

Rhipicephalus capensis (Acari: Ixodidae), A geographically restricted South African tick, returning with a human traveler to the United States.

Accelerated frequency of recreational travel, globalization of business, and legal and illegal plant and animal trades have contributed to enduring introductions of exotic ticks into the United States. We herein report a new incursion of a female Rhipicephalus capensis on a human traveler returning to Connecticut from South Africa. Natural distribution of R. capensis is restricted to the Western Cape Province and southwestern portion of the Northern Cape Province of South Africa, an area called the Fynbos Biome, and adults of this species primarily parasitize large, wild ungulate hosts. Only one previous international introduction of this tick is documented on imported South African plant material into the United States in 1985. The specimen described here was identified initially by morphological means and subsequently, a partial DNA sequence for the mitochondrial ribosomal RNA gene was generated in a PCR assay, which showed 94.86% identity to an R. capensis sequence in GenBank. We also provide information on several other previously unreported or under-reported incursions by South African ticks into the United States in association with imported Fynbos floricultural materials and speckled Cape tortoises, Chersobius signatus. Documentation of these additional exotic tick species incursions highlights ongoing challenges of the international movement of humans, animals, and other goods carrying ticks of human and veterinary importance.

A Multistate Comparison Study of COVID-19 Cases Among Accredited and Nonaccredited Nursing Homes.

Widely acknowledged is the disproportionate number of COVID-19 cases among nursing home residents. This observational study examined the relationship between accreditation status and COVID-19 case rates in states where the numbers and proportions of Joint Commission accredited facilities made such comparisons possible (Illinois (IL), Florida (FL), and Massachusetts (MA)). COVID-19 data were accessed from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare Public Use File, which included retrospective COVID-19 data submitted by nursing homes to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network. The outcome variable was the total number of nursing home-identified COVID-19 cases from June 2020 to January 2021. Joint Commission accreditation status was the independent variable. Mediating factors included state, and county-level case rates. Increases in the county rate had a significant association with higher nursing home COVID-19 case rates (p < .001). After adjusting for county case rates, no differences were observed in the mean group case rates for accredited and nonaccredited nursing homes. However, comparing predicted case rates to actual case rates revealed that accredited nursing homes were more closely aligned with their predicted rates. Performance of the nonaccredited nursing homes was more variable and had proportionally more outliers compared to accredited nursing homes. Community prevalence of COVID-19 is the strongest predictor of nursing home cases. While accreditation status did not have an impact on overall mean group performance, nonaccredited nursing homes had greater variation in performance and a higher proportion of negative outliers. Accreditation was associated with more consistent performance during the COVID-19 pandemic, despite being located in counties with a higher prevalence of COVID-19.

Integrated Tick Management in Guilford, CT: Fipronil-Based Rodent-Targeted Bait Box Deployment Configuration and Peromyscus leucopus (Rodentia: Cricetidae) Abundance Drive Reduction in Tick Burdens.

Integrated tick management (ITM) is a comprehensive strategy used to reduce presence of ticks and their associated pathogens. Such strategies typically employ a combination of host and non-host targeted treatments which often include fipronil-based, rodent-targeted bait boxes. Bait boxes target small-bodied rodents, specifically white-footed mice (Peromyscus leucopus Rafinesque) that not only play a crucial role in the blacklegged tick (Ixodes scapularis Say (Ixodida: Ixodidae)) life cycle, but also in the transmission of numerous pathogens, primarily Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner (Spirochaetales: Spirochaetaceae), the causal agent of Lyme disease. This study aimed to determine the effect of bait box deployment configuration on tick burden reduction while also further exploring bait consumption and P. leucopus abundances as measures of bait box usage and effectiveness. Boxes were deployed on nine properties within each of six neighborhoods (n = 54) in two different configurations: grid and perimeter. Multiple factors were analyzed as potential predictors for reduction in tick burdens using a backward stepwise selection procedure. Results confirmed the perimeter configuration was a more effective deployment strategy. In addition, overall P. leucopus abundance was a significant predictor of tick burden reduction while bait consumption was not. These findings not only further support the recommended perimeter deployment configuration but provide insight into effective utilization in areas of high P. leucopus abundance. The identification of this significant relationship, in addition to configuration, can be utilized by vector control professionals and homeowners to make informed decisions on bait box placement to make sustained impacts on the I. scapularis vector and associated pathogens within an ITM framework.

First Record of Established Populations of the Invasive Pathogen Vector and Ectoparasite Haemaphysalis longicornis (Acari: Ixodidae) in Connecticut, United States.

A number of invasive tick species capable of transmitting pathogens have been accidentally introduced into the U.S. in recent years. The invasion and further range expansion of these exotic ticks have been greatly facilitated by frequent global travel and trade as well as increases in legal and illegal importation of animals. We describe the discovery of the first established populations of Haemaphysalis longicornis Neumann and the first fully engorged human parasitizing specimen documented through passive tick surveillance in Fairfield County, Connecticut, U.S. We also report several individual specimens of this invasive arthropod and vector of multiple pathogens of medical and veterinary importance collected through active tick surveillance from three counties (Fairfield, New Haven, and New London). Considering the potential for invasive ticks to transmit numerous native and emerging pathogens, the implementation of comprehensive surveillance programs will aid in prompt interception of these ticks and reduce the risk of infection in humans and wildlife.

Effective control of the motile stages of Amblyomma americanum and reduced Ehrlichia spp. prevalence in adults via permethrin treatment of white-tailed deer in coastal Connecticut, USA.

The lone star tick, Amblyomma americanum, is a common human-biting species whose range has been largely restricted to the southeastern United States, until recent detections of established populations on Long Island, New York and throughout coastal southern New England. We evaluated the effectiveness of topical treatment of 10 % permethrin delivered via 4-poster devices to white-tailed deer, Odocoileus virginianus, in the management of a newly discovered A. americanum population in Norwalk, Connecticut. Using a high-density deployment of one 4-poster device/12.7 ha, we were successful in significantly reducing densities of host-seeking adults (93 % reduction), nymphs (92 %), and larvae (96 %) from 2018 to 2020. We also documented a significant reduction (87 %) in parasitizing adults and nymphs on white-tailed deer from 2018 to 2019. The prevalence of Ehrlichia chaffeensis and Ehrlichia ewingii combined in host-seeking adults declined significantly from 47 % at the time the A. americanum population was discovered in 2017 to 7% in 2020. However, the prevalence in nymphs remained static (∼9%) throughout the study period. These data demonstrate that, when properly deployed in a density-dependent manner in terms of deer abundance, 4-poster devices can effectively manage parasitizing and host-seeking A. americanum populations and reduce the prevalence of two ehrlichial species of public health importance.