Healthcare Provider Confidence and Perceived Barriers to Diagnosing Illness Associated with Harmful Algal Blooms.

Introduction: Illnesses caused by harmful algal blooms can vary in clinical presentation and severity depending on the types of algae, cyanobacteria, or toxins involved as well as the route and extent of exposure. These illnesses are primarily diagnoses of exclusion owing to lack of access to clinical testing for harmful algal bloom toxins. We used a national survey of healthcare providers to explore self-reported confidence and perceived barriers to diagnosing harmful algal bloom-associated illnesses. Methods: We conducted a descriptive analysis (SAS 9.4) of 2 questions from a national survey of healthcare providers administered September 14-October 26, 2020 (N=1,503). Chi-square tests were used to assess differences between groups, with statistical significance defined as p<0.05. Results: Most (68%) providers reported little to no confidence in their ability to identify illnesses caused by harmful algal blooms, 17% were confident or very confident, and 15% reported not seeing patients with these illnesses. Responses differed by specialization, work setting, sex, experience, whether pediatric patients were seen, and number of patients seen. Respondents regularly using resources such as newspapers (31%), professional societies (29%), and government health agencies (26%) reported increased confidence. Of 1,283 (85%) respondents who were asked about barriers to accurately diagnosing patients with these illnesses, 71% selected lack of knowledge about harmful algal bloom-associated illnesses as a barrier. Conclusions: Provider confidence in identifying harmful algal bloom-associated illnesses was low, and lack of knowledge was identified as a primary barrier, suggesting that more outreach and education are needed. Tailoring information for specific provider audiences and providing it through highly frequented channels could increase providers' confidence in identifying and diagnosing harmful algal bloom-associated illnesses.

Cronobacter sakazakii Infections in Two Infants Linked to Powdered Infant Formula and Breast Pump Equipment - United States, 2021 and 2022.

Cronobacter sakazakii, a species of gram-negative bacteria belonging to the Enterobacteriaceae family, is known to cause severe and often fatal meningitis and sepsis in young infants. C. sakazakii is ubiquitous in the environment, and most reported infant cases have been attributed to contaminated powdered infant formula (powdered formula) or breast milk that was expressed using contaminated breast pump equipment (1-3). Previous investigations of cases and outbreaks have identified C. sakazakii in opened powdered formula, breast pump parts, environmental surfaces in the home, and, rarely, in unopened powdered formula and formula manufacturing facilities (2,4-6). This report describes two infants with C. sakazakii meningitis reported to CDC in September 2021 and February 2022. CDC used whole genome sequencing (WGS) analysis to link one case to contaminated opened powdered formula from the patient's home and the other to contaminated breast pump equipment. These cases highlight the importance of expanding awareness about C. sakazakii infections in infants, safe preparation and storage of powdered formula, proper cleaning and sanitizing of breast pump equipment, and using WGS as a tool for C. sakazakii investigations.

(Mis)perception and Use of Unsterile Water in Home Medical Devices, PN View 360+ Survey, United States, August 20211.

Tap water is not sterile, and its use in home medical devices can result in infections from waterborne pathogens. However, many participants in a recent survey in the United States said tap water could safely be used for home medical devices. These results can inform communication materials to reduce the high consequence of infections.

Public health branch incident management and support as part of the Federal Government response during the emergency phase of Hurricanes Irma and Maria in Puerto Rico and the US Virgin Islands.

On September 6 and 20, 2017, Hurricanes Irma and Maria made landfall as major hurricanes in the US Caribbean Territories of the Virgin Islands and Puerto Rico with devastating effects. As part of the initial response, a public health team (PHT) was initially deployed as part of the US Department of Health and Human Services Incident Response Coordination Team. As a result of increased demands for additional expertise and resources, a public health branch (PHB) was established for coordinating a broad spectrum of public health response activities in support of the affected territories. This paper describes the conceptual framework for organizing these activities; summarizes some key public health activities and roles; outlines partner support and coordination with key agencies; and defines best practices and areas for improvement in disaster future operations.

Characteristics Associated with Adults Remembering to Wash Hands in Multiple Situations Before and During the COVID-19 Pandemic - United States, October 2019 and June 2020.

Washing hands often, especially during times when one is likely to acquire and spread pathogens,* is one important measure to help prevent the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), as well as other pathogens spread by respiratory or fecal-oral transmission (1,2). Studies have reported moderate to high levels of self-reported handwashing among adults worldwide during the COVID-19 pandemic (3-5)†; however, little is known about how handwashing behavior among U.S. adults has changed since the start of the pandemic. For this study, survey data from October 2019 (prepandemic) and June 2020 (during pandemic) were compared to assess changes in adults' remembering to wash their hands in six situations.§ Statistically significant increases in reported handwashing were seen in June 2020 compared with October 2019 in four of the six situations; the odds of remembering to wash hands was 2.3 times higher among respondents after coughing, sneezing, or blowing their nose, 2.0 times higher before eating at a restaurant, and 1.7 times higher before eating at home. Men, young adults aged 18-24 years, and non-Hispanic White (White) adults were less likely to remember to wash hands in multiple situations. Strategies to help persons remember to wash their hands frequently and at important times should be identified and implemented, especially among groups reporting low prevalence of remembering to wash their hands.

Associations Among School Absenteeism, Gastrointestinal and Respiratory Illness, and Income - United States, 2010-2016.

Control of communicable diseases in children, including respiratory and diarrheal illnesses that affect U.S. school-aged children, might require public health preventive efforts both in the home and at school, a primary setting for transmission. National Health Interview Survey (NHIS) data on school absenteeism and gastrointestinal and respiratory illnesses in the United States during 2010-2016 were analyzed to examine their associations with income. Prevalence of gastrointestinal and respiratory illnesses (queried for the 2 weeks preceding the survey) increased as income decreased. The likelihood of missing any school days during the past year decreased with reduced income. However, among children who missed school, those from low-income households missed more days of school than did children from higher income households. Although the reason for absenteeism cannot be ascertained from this analysis, these data underscore the importance of preventive measures (e.g. hand hygiene promotion and education) and the opportunity for both homes and schools to serve as important points for implementation of public health preventive measures, including improved hand hygiene practices.

Associations Among School Absenteeism, Gastrointestinal and Respiratory Illness, and Income - United States, 2010-2016.

Control of communicable diseases in children, including respiratory and diarrheal illnesses that affect U.S. school-aged children, might require public health preventive efforts both in the home and at school, a primary setting for transmission. National Health Interview Survey (NHIS) data on school absenteeism and gastrointestinal illness in the United States during 2010-2016 were analyzed to identify associations among income, illness, and absenteeism. Prevalence of gastrointestinal and respiratory illnesses in the 2 weeks preceding the survey increased as income decreased. Although the likelihood of missing any school days during the past year decreased with reduced income, among children missing school, those from low-income households missed more days of school than did children from higher income households. Although the reason for absenteeism cannot be ascertained from this analysis, these data underscore the importance of preventive measures, such as hand hygiene promotion and education, and the opportunity for both homes and schools to serve as an important point for implementation of public health preventive measures, including hand hygiene practice and education.