Extended-Spectrum Beta-Lactamase Shigella sonnei Cluster Among Men Who Have Sex with Men in Chicago, Illinois-July-October 2022.

Drug-resistant shigellosis is increasing, particularly among men who have sex with men (MSM). During July-October 2022, an extended-spectrum beta-lactamase producing Shigella sonnei cluster of 9 patients was identified in Chicago, of whom 8 were MSM and 6 were festival attendees. The cluster also included 4 domestic travelers to Chicago. Sexual health care for MSM should include shigellosis diagnosis and prevention.

SARS-CoV-2 Reinfection Risk in Persons with HIV, Chicago, Illinois, USA, 2020-2022.

Understanding if persons with HIV (PWH) have a higher risk for SARS-CoV-2 reinfection may help tailor future COVID-19 public health guidance. To determine whether HIV infection was associated with increased risk for SARS-CoV-2 reinfection, we followed adult residents of Chicago, Illinois, USA, with SARS-CoV-2 longitudinally from their first reported infection through May 31, 2022. We matched SARS-CoV-2 laboratory data and COVID-19 vaccine administration data to Chicago's Enhanced HIV/AIDS Reporting System. Among 453,587 Chicago residents with SARS-CoV-2, a total of 5% experienced a SARS-CoV-2 reinfection, including 192/2,886 (7%) PWH and 23,642/450,701 (5%) persons without HIV. We observed higher SARS-CoV-2 reinfection incidence rates among PWH (66 [95% CI 57-77] cases/1,000 person-years) than PWOH (50 [95% CI 49-51] cases/1,000 person-years). PWH had a higher adjusted rate of SARS-CoV-2 reinfection (1.46, 95% CI 1.27-1.68) than those without HIV. PWH should follow the recommended COVID-19 vaccine schedule, including booster doses.

Mpox among Public Festival Attendees, Chicago, Illinois, USA, July-August 2022.

We investigated an mpox outbreak after a 2022 LGBTQ event in Chicago, Illinois, USA. Among case-patients, 38% had received 1 dose of mpox vaccine, none 2 doses; most reported sexual activity during the probable exposure period. Among other preventive measures, persons at risk should complete mpox vaccination 14 days before an event.

t(14;18) Translocations in Dioxin-Exposed Workers.

OBJECTIVE: To determine if occupational exposure to dioxins is associated with an increased frequency of t(14;18) translocations. METHODS: A cross-sectional analysis of serum dioxin levels and t(14;18) frequencies in peripheral blood mononuclear cells in 218 former chemical plant workers and 150 population controls. RESULTS: The workers had significantly higher geometric mean serum levels of 2,3,7,8-TCDD (26.2 vs 2.5 ppt) and TEQ (73.8 vs 17.7 ppt) than controls. There were no significant differences in the prevalence or frequency of t(14;18) translocations in the workers compared to controls. Among former workers with current or past chloracne who were t(14;18) positive, the frequency of translocations significantly increased with quartiles of 2,3,7,8-TCDD and TEQ. CONCLUSION: Chloracne appears to modulate the association between dioxin exposure and increased frequency of t(14;18) translocations.

Community-Based Testing for SARS-CoV-2 - Chicago, Illinois, May-November 2020.

On May 13, 2020, Chicago established a free community-based testing (CBT) initiative for SARS-CoV-2, the virus that causes COVID-19, using reverse transcription-polymerase chain reaction (RT-PCR). The initiative focused on demographic groups and geographic areas that were underrepresented in testing by clinical providers and had experienced high COVID-19 incidence, including Hispanic persons and those who have been economically marginalized. To assess the CBT initiative, the Chicago Department of Public Health (CDPH) compared demographic characteristics, economic marginalization, and test positivity between persons tested at CBT sites and persons tested in all other testing settings in Chicago. During May 13-November 14, a total of 253,904 SARS-CoV-2 RT-PCR tests were conducted at CBT sites. Compared with those tested in all other testing settings in Chicago, persons tested at CBT sites were more likely to live in areas that are economically marginalized (38.6% versus 32.0%; p<0.001) and to be Hispanic (50.9% versus 20.7%; p<0.001). The cumulative percentage of positive test results at the CBT sites was higher than that at all other testing settings (11.1% versus 7.1%; p<0.001). These results demonstrate the ability of public health departments to establish community-based testing initiatives that reach communities with less access to testing in other settings and that experience disproportionately higher incidences of COVID-19.

Mumps Cases Disproportionately Affecting Persons Living with HIV Infection and Men Who Have Sex with Men - Chicago, Illinois, 2018.

During January 1-March 2, 2018, the number of mumps cases among adults reported to the Chicago Department of Public Health (CDPH) doubled compared with the same period in 2017. In response, CDPH created a supplementary questionnaire to collect additional information on populations affected and potential transmission routes. An epidemiologic analysis of routine and supplementary data, including spatiotemporal analysis, was performed to describe mumps cases reported to CDPH during 2018. A fourfold increase in mumps cases was reported during 2018 compared with 2017, with men who have sex with men (MSM) and persons living with human immunodeficiency virus (HIV) infection disproportionately represented among cases. A spatiotemporal, residential cluster was identified in a 9-square-mile area within six adjacent communities. The majority of persons affected were MSM, and this area was visited by many other persons with mumps diagnoses. Spatiotemporal analyses could be used in real time to identify case clusters to target public health response efforts, including to guide recommendations for additional measles, mumps, and rubella (MMR) vaccine and to identify specific transmission venues.

Community Transmission of SARS-CoV-2 at Two Family Gatherings - Chicago, Illinois, February-March 2020.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019. Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3). However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts. In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19. Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2. This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission. U.S residents should follow stay-at-home orders when required by state or local authorities.

The 2014 crude 4-methylcyclohexanemethanol chemical release and birth outcomes in West Virginia.

Approximately 10,000 gallons of crude 4-methylcyclohexanemethanol and propylene glycol phenyl ether were accidentally released into the Elk River upstream from a water treatment facility in West Virginia. The objective of this study was to use logistic and Poisson regression analyses to determine the effect potential exposures had on adverse birth outcomes (birth weight, small for gestational age, and abnormal Apgar score). We adjusted for confounding factors and assessed prevalence of adverse birth outcomes by residential location and timing of the pregnancy. There were no statistically significant interactions between residential location and timing of the pregnancy (range of p values: .157-.806). Changes in the prevalence of birth outcomes were consistent before and after the spill regardless of residential location. There was no evidence of an association between adverse birth outcomes and potential exposure to the released chemicals.

The influence of demographic, physical, behavioral, and dietary factors on hemoglobin adduct levels of acrylamide and glycidamide in the general U.S. population.

PURPOSE: This study aims to better understand the individual characteristics and dietary factors that affect the relationship between estimated consumption of acrylamide and measured acrylamide hemoglobin adduct levels (HbAA) and glycidamide hemoglobin adduct levels (HbGA). METHODS: Acrylamide levels in individual food items, estimated by the U.S. Food and Drug Administration, were linked to data collected in the 2003-2004 National Health and Nutrition Examination Survey. Multivariable linear regression was used to evaluate the relationship between estimated consumption of acrylamide and HbAA. RESULTS: A significant association between acrylamide intake and HbAA was observed, after adjustment for gender, race/ethnicity, smoking status, age, and BMI (R2 = 0.34). Across quartiles of acrylamide consumption, HbAA and HbGA levels increased monotonically. Among nonsmokers, an evaluation of three heavily consumed, high AA concentration foods showed a positive trend between the consumed amount of fried potatoes and HbAA in children, adolescents, and adults. A significant positive trend between the consumed amount of potato chips or coffee was indicated in adolescents, adults, and seniors. CONCLUSIONS: Consumption of some individual foods affects HbAA concentrations more strongly and in an age-dependent manner. Our results suggest that effective dietary guidelines for controlling acrylamide intake should be subpopulation specific.

Lung cancer mutation profile of EGFR, ALK, and KRAS: Meta-analysis and comparison of never and ever smokers.

Lung cancer is the leading cause of cancer-related mortality. While the majority of lung cancers are associated with tobacco smoke, approximately 10-15% of U.S. lung cancers occur in never smokers. Evidence suggests that lung cancer in never smokers appears to be a distinct disease caused by driver mutations which are different than the genetic pathways observed with lung cancer in smokers. A meta-analysis of human epidemiologic data was conducted to evaluate the profile of common or therapy-targetable mutations in lung cancers of never and ever smokers. Epidemiologic studies (N=167) representing over 63,000 lung cancer cases were identified and used to calculate summary odds ratios for lung cancer in never and ever smokers containing gene mutations: EGFR, chromosomal rearrangements and fusion of EML4 and ALK, and KRAS. This analysis also considered the effect of histopathology, smoking status, sex, and ethnicity. There were significantly increased odds of presenting the EGFR and ALK-EML4 mutations in 1) adenocarcinomas compared to non-small cell lung cancer and 2) never smokers compared to ever smokers. The prevalence of EGFR mutations was higher in Asian women as compared to women of Caucasian/Mixed ethnicity. As the smoking history increased, there was a decreased odds for exhibiting the EGFR mutation, particularly for cases >30 pack-years. Compared to ever smokers, never smokers had a decreased odds of KRAS mutations among those of Caucasian/Mixed ethnicity (OR=0.22, 95% CI: 0.17-0.29) and those of Asian ethnicity (OR=0.39, 95% CI: 0.30-0.50). Our findings show that key driver mutations and several patient features are highly prevalent in lung cancers of never smokers. These associations may be helpful as patient demographic models are developed to predict successful outcomes of targeted therapeutic interventions NSCLC.

An assessment of formaldehyde emissions from laminate flooring manufactured in China.

Formaldehyde emissions from two laminate flooring products, labeled as California Air Resources Board (CARB) compliant, were evaluated. Passive 24-hr samples (n = 79) and real-time measurements were collected following installation and removal of the products in two rooms of similar size. Mean formaldehyde concentrations following installation were 0.038 and 0.022 ppm for Products 1 and 2 respectively, and 7 days after flooring removal the concentrations returned to background pre-installation levels. Both products were also evaluated in a small chamber (ASTM D6007) using Deconstructive (de-laminated product) and Non-Deconstructive (intact product) methods. Deconstructive testing showed that Product 1 exceeded the applicable CARB emission standard by 4-fold, while Product 2 was equivalent to the standard. Non-Deconstructive measurements were far below the Deconstructive results and were used to predict 24-hr steady-state room air concentrations. Based on the products that we tested (one of which was found to not be compliant with the CARB standard), the airborne formaldehyde concentrations measured following installation in a real-world setting would not be expected to elicit adverse acute health effects.

An updated evaluation of reported no-observed adverse effect levels for chrysotile asbestos for lung cancer and mesothelioma.

Although consumption of chrysotile asbestos has decreased since the 1970s, the latency period of asbestos-related cancers is thought to be at least 20-30 years, and therefore the potential health risks associated with historical exposures is still actively researched. This analysis represents an update to a previous paper in which we evaluated the exposure-response relationships for lung cancer and mesothelioma in chrysotile-exposed cohorts. Here, we review several recently published studies as well as updated information from previous studies. For each of the 14 studies considered, we identified the "no-observed adverse effect level" (NOAEL) for lung cancer and/or mesothelioma. NOAEL values for lung cancer ranged from 1.1 to <20 f/cc-years to 1600-3200 f/cc-years, and for mesothelioma ranged from 100-400 f/cc-years to 800-1599 f/cc-years. The range of "best estimate" NOAELs was estimated to be 89-168 f/cc-years for lung cancer and 208-415 f/cc-years for mesothelioma. None of the six cohorts of cement or friction product manufacturing workers exhibited an increased lung cancer risk at any exposure level, while all of the five studies of textile workers reported an increased risk at one or more exposure levels. This is likely because friction and cement workers were exposed to much shorter chrysotile fibers. Of the seven cases of peritoneal mesothelioma reported in the included studies, none were observed in the analyses of cement or friction product manufacturing workers in the absence of crocidolite exposure. These findings will help characterize potential worker and consumer health risks associated with historical and current chrysotile exposures.

Effects of the NFL's Amendments to the Free Kick Rule on Injuries during the 2010 and 2011 Seasons.

Recognizing the chronic health effects associated with playing football, the National Football League (NFL) has enacted policies and rules aimed at improving player health and safety. Prior to the 2011 season, amendments to the Free Kick rule were implemented, whereby the restraining line was moved from the 30- to the 35-yard line and all kicking team players other than the kicker were required to line up no more than 5 yards behind their restraining line. The objective of this analysis was to evaluate the effects of these rule changes on injury rates. Data for injuries occurring on special teams plays during the 2010 and 2011 NFL seasons were obtained from publically available NFL gamebooks and injury reports. Injury rates for kickoff plays across seasons were statistically compared using incidence rate ratios (RR) and 95% confidence intervals. To evaluate whether injury rate changes could be attributable to the rule amendments, comparisons were made with punt injury rates (presumably unaffected by the Free Kick rule changes) and distributions of potential confounders were assessed across seasons. Incidence of injuries occurring on kickoff plays fell from 2010 to 2011 (RR: 0.45, 95% CI: 0.28-0.73), although on kickoff plays where the ball was returned, this decrease became non-significant (RR: 0.67, 95% CI: 0.41-1.08). While the incidence of head injuries decreased by approximately 3-fold during kickoff plays, this change was not statistically significant (RR: 0.33, 95% CI: 0.09-1.21). No difference was observed in injury incidence during punts between the two seasons, and the distribution of confounding factors was largely uniform across seasons. The observed decrease in injuries occurring during kickoffs was likely directly attributable to the Free Kick rule amendments, principally from the increased frequency of touchbacks. The absence of a significant change in head injuries during kickoffs was unexpected, but may be attributable to small sample size. Despite the injury rate reductions, the rule changes likely had little effect on player safety during active gameplay.

Characterizing the relationship between in-hospital measures and workers' compensation outcomes among severely injured construction workers using a data linkage strategy.

BACKGROUND: To characterize the relationship between acute measures of severity and three important workers' compensation outcomes associated with a worker's ability to return to work and the cost of a work-related injury. METHODS: Probabilistic data linkage of workers' compensation claims made by injured construction workers from 2000 to 2005 with two Illinois medical record registries. Multivariable robust regression models were built to assess the relationship between three in-hospital measures and three outcomes captured in the Workers' Compensation data. RESULTS: In the final multivariable models, a categorical increase in injury severity was associated with an extra $7,830 (95% CI: $4,729-$10,930) of monetary compensation awarded, though not with temporary total disability (TTD) or permanent partial disability (PPD). Our models also predicted that every extra day spent in the hospital results in an increase of 0.51 (95% CI: 0.23-0.80) weeks of TTD and an extra $1,248 (95% CI: $810-$1,686) in monetary compensation. Discharge to an intermediate care facility following the initial hospitalization was associated with an increase of 8.15 (95% CI: 4.03-12.28) weeks of TTD and an increase of $23,440 (95% CI: $17,033-$29,847) in monetary compensation. CONCLUSIONS: We were able to link data from the initial hospitalization for an injured worker with the final workers' compensation claims decision or settlement. The in-hospital measures of injury severity were associated with total monetary compensation as captured in the workers' compensation process.

Analysis of ethnic disparities in workers' compensation claims using data linkage.

OBJECTIVE: The overall goal of this research project was to assess ethnic disparities in monetary compensation among construction workers injured on the job through the linkage of medical records and workers' compensation data. METHODS: Probabilistic linkage of medical records with workers' compensation claim data. RESULTS: In the final multivariable robust regression model, compensation was $5824 higher (P = 0.030; 95% confidence interval: 551 to 11,097) for white non-Hispanic workers than for other ethnic groups when controlling for injury severity, affected body region, type of injury, average weekly wage, weeks of temporary total disability, percent permanent partial disability, death, or attorney use. CONCLUSIONS: The analysis indicates that white non-Hispanic construction workers are awarded higher monetary settlements despite the observation that for specific injuries the mean temporary total disability and permanent partial disability were equivalent to or lower than those in Hispanic and black construction workers.

Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for reporting methicillin-resistant Staphylococcus aureus infections at a hospital in Illinois.

BACKGROUND: States, including Illinois, have passed legislation mandating the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reporting healthcare-associated infections, such as methicillin-resistant Staphylococcus aureus (MRSA). OBJECTIVE: To evaluate the sensitivity of ICD-9-CM code combinations for detection of MRSA infection and to understand implications for reporting. METHODS: We reviewed discharge and microbiology databases from July through August of 2005, 2006, and 2007 for ICD-9-CM codes or microbiology results suggesting MRSA infection at a tertiary care hospital near Chicago, Illinois. Medical records were reviewed to confirm MRSA infection. Time from admission to first positive MRSA culture result was evaluated to identify hospital-onset MRSA (HO-MRSA) infections. The sensitivity of MRSA code combinations for detecting confirmed MRSA infections was calculated using all codes present in the discharge record (up to 15); the effect of reviewing only 9 diagnosis codes, the number reported to the Centers for Medicare and Medicaid Services, was also evaluated. The sensitivity of the combination of diagnosis codes for detection of HO-MRSA infections was compared with that for community-onset MRSA (CO-MRSA) infections. RESULTS: We identified 571 potential MRSA infections with the use of screening criteria; 403 (71%) were confirmed MRSA infections, of which 61 (15%) were classified as HO-MRSA. The sensitivity of MRSA code combinations was 59% for all confirmed MRSA infections when 15 diagnoses were reviewed compared with 31% if only 9 diagnoses were reviewed (P < .001). The sensitivity of code combinations was 33% for HO-MRSA infections compared with 62% for CO-MRSA infections (P < .001). CONCLUSIONS: Limiting analysis to 9 diagnosis codes resulted in low sensitivity. Furthermore, code combinations were better at revealing CO-MRSA infections than HO-MRSA infections. These limitations could compromise the validity of ICD-9-CM codes for interfacility comparisons and for reporting of healthcare-associated MRSA infections.