Outbreak of Human Trichinellosis - Arizona, Minnesota, and South Dakota, 2022.

Trichinellosis is a parasitic zoonotic disease transmitted through the consumption of meat from animals infected with Trichinella spp. nematodes. In North America, human trichinellosis is rare and is most commonly acquired through consumption of wild game meat. In July 2022, a hospitalized patient with suspected trichinellosis was reported to the Minnesota Department of Health. One week before symptom onset, the patient and eight other persons shared a meal that included bear meat that had been frozen for 45 days before being grilled and served rare with vegetables that had been cooked with the meat. Investigation identified six trichinellosis cases, including two in persons who consumed only the vegetables. Motile Trichinella larvae were found in remaining bear meat that had been frozen for >15 weeks. Molecular testing identified larvae from the bear meat as Trichinella nativa, a freeze-resistant species. Persons who consume meat from wild game animals should be aware that that adequate cooking is the only reliable way to kill Trichinella parasites and that infected meat can cross-contaminate other foods.

Changes in Patterns of Trauma Injuries in the Dakotas Region During the COVID-19 Pandemic.

BACKGROUND: The aim of this study is to compare impact of COVID-19 on trauma volume and characteristics on a set of trauma centers with a rural catchment area. The COVID-19 pandemic has affected different parts of the country quite differently, both in case volume and in local responses. State-wide responses have varied considerably, including variations in local mask mandates, school closures, and social distancing measures. METHODS: This was a retrospective trauma registry review of patients who were admitted to three of the tertiary care trauma centers in North and South Dakota between 2014 through 2022. RESULTS: In the analysis of 36,397 patients, we found a significant increase in trauma patient volume during the COVID-19 pandemic, with an increased percentage of patients presenting with a mechanism of injury secondary to abuse or assault. This increase in patient volume continued to rise during 2021 and 2022. CONCLUSIONS: Our study demonstrates how the COVID-19 pandemic impacted trauma center admissions in the rural and frontier Midwest differently from more urban areas, and the importance of including a variety of settings in trauma research.

Sensitivity of US Preventive Services Task Force and PLCOm2012 lung cancer screening eligibility criteria in individuals with lung cancer in South Dakota self-reporting as Indigenous and non-Indigenous.

BACKGROUND: Lung cancer is the leading cause of cancer deaths. Screening individuals who are at elevated risk using low-dose computed tomography reduces lung cancer mortality by ≥20%. Individuals who have community-based factors that contribute to an increased risk of developing lung cancer have high lung cancer rates and are diagnosed at younger ages. In this study of lung cancer in South Dakota, the authors compared the sensitivity of screening eligibility criteria for self-reported Indigenous race and evaluated the need for screening at younger ages. METHODS: US Preventive Services Task Force (USPSTF) 2013 and 2021 (USPSTF2013 and USPSTF2021) criteria and two versions of the PLCOm2012 risk-prediction model (based on the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial), one with a predictor for race and one without, were applied at USPSTF-equivalent thresholds of ≥1.7% in 6 years and ≥1.0% in 6 years to 1565 individuals who were sequentially diagnosed with lung cancer (of whom 12.7% self-reported as Indigenous) at the Monument Health Cancer Care Institute in South Dakota (2010-2019). RESULTS: Eligibility sensitivities of USPSTF criteria did not differ significantly between individuals who self-reported their race as Indigenous and those who did not (p > .05). Sensitivities of both PLCOm2012 models were significantly higher than comparable USPSTF criteria. The sensitivity of USPSTF2021 criteria was 66.1% and, for comparable PLCOm2012 models with and without race, sensitivity was 90.7% and 89.6%, respectively (both p < .001); 1.4% of individuals were younger than 50 years, and proportions did not differ by Indigenous classification (p = .518). CONCLUSIONS: Disparities in screening eligibility were not observed for individuals who self-reported their race as Indigenous. USPSTF criteria had lower sensitivities for lung cancer eligibility. Both PLCOm2012 models had high sensitivities, with higher sensitivity for the model that included race. The PLCOm2012noRace model selected effectively in this population, and screening individuals younger than 50 years did not appear to be justified. PLAIN LANGUAGE SUMMARY: Lung cancer is the leading cause of cancer deaths. Studies show that using low-dose computed tomography scans to screen people who smoke or who used to smoke and are at elevated risk for lung cancer reduces lung cancer deaths. This study of 1565 individuals with lung cancer in South Dakota compared screening eligibility using US Preventive Services Task Force (USPSTF) criteria and a lung cancer risk-prediction model (PLCOm2012; from the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial). The model had higher sensitivity and picked more people with lung cancer to screen compared with USPSTF criteria. Eligibility sensitivities were similar for individuals who self-reported as Indigenous versus those who did not between USPSTF criteria and the model.

Unique SARS-CoV-2 Variants, Tourism Metrics, and B.1.2 Emergence in Early COVID-19 Pandemic: A Correlation Analysis in South Dakota.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, which is the source of the coronavirus disease 2019 (COVID-19), was declared a pandemic in the March of 2020. Travel and tourism were severely impacted as restrictions were imposed to help slow the disease spread, but some states took alternative approaches to travel restrictions. This study investigated the spread of COVID-19 in South Dakota during the early pandemic period to better understand how tourism affected the movement of the virus within the region. Sequences from the fall of 2020 were retrieved from public sources. CDC and other sources were used to determine infections, deaths, and tourism metrics during this time. The data were analyzed using correlation and logistic regression. This study found that the number of unique variants per month was positively correlated with hotel occupancy, but not with the number of cases or deaths. Interestingly, the emergence of the B.1.2 variant in South Dakota was positively correlated with increased case numbers and deaths. Data show that states with a shelter-in-place order were associated with a slower emergence of the B.1.2 variant compared to states without such an order, including South Dakota. Findings suggest complex relationships between tourism, SARS-CoV-2 infections, and mitigation strategies. The unique approach that South Dakota adopted provided insights into the spread of the disease in areas without state-wide restrictions. Our results suggest both positive and negative aspects of this approach. Finally, our data highlight the need for future surveillance efforts, including efforts focused on identifying variants with known increased transmission potential to produce effective population health management.

Substance Use Disorder in Adults with ADHD in South Dakota.

INTRODUCTION: Attention-deficit hyperactivity disorder (ADHD) increases the risk for multiple comorbid psychiatric disorders, such as substance use disorder. Comorbid ADHD and substance use disorder has been shown to increase the risk of adverse occupational, social, psychological, and physical outcomes. Because of the severe risks of substance use, it is useful to determine the relative comorbidity of ADHD among different types of substance use disorders. This study examined the prevalence of ADHD in residential addiction treatment as well as the relative prevalence of ADHD among mono-substance use, comorbid substance use (2 comorbid substance use disorders), and polysubstance use (3+ substance use disorders). METHODS: Participants were adults admitted to residential treatment of substance use disorder. Participants were asked to complete a Wender Utah ADHD rating scale to assess the presence of ADHD. A cutoff score of 46 was used to determine presence of ADHD in this rating assessment. Participants were also provided with an ADHD history questionnaire designed for this study to gather information on childhood ADHD diagnoses, substance use history, and early-life effects o f attention disorders. RESULTS: Using the Wender Utah assessment scores, 55 participants with substance use disorder demonstrated an ADHD prevalence of 45% (n=30). Of the study population, 20% (n=11) of participants being diagnosed in childhood and another 25% (n=14) having a positive Wender Utah questionnaire score for ADHD as adult patients without a childhood diagnosis. All participants who had a childhood diagnosis of ADHD had received treatment for this disorder. Polysubstance use disorder (n=21) had an ADHD prevalence of 62%. Alcohol use disorder (n=21) had an ADHD prevalence of 24%. Methamphetamine use disorder (n=4) had an ADHD prevalence of 75%. Participants with ADHD (either during childhood or adulthood) had a nearly significant increase in the prevalence of polysubstance use disorder as compared to participants without ADHD (p = 0.0542). CONCLUSIONS: ADHD and substance use disorder have notable comorbidity. This study, among similar studies, demonstrates a high prevalence of ADHD in populations with substance use disorder. The presence of ADHD in patients with substance use disorder may influence which substances those patients choose to use. The difference in patients treated for childhood ADHD and those having a diagnosis of ADHD demonstrates a deficit in effective childhood ADHD screening. As such, effective screening and prevention of substance use disorder in patients with ADHD may be a useful tool in reducing the risk of developing substance use disorder. Additionally, adequate treatment of ADHD could be considered useful in treating a contributing element of substance use disorder.

Health Challenges in South Dakota: Creation of Healthcare Provider Referral List for Special Olympic Athletes.

INTRODUCTION: Individuals with intellectual and developmental disabilities (IDD) face significant health challenges affecting their overall morbidity and mortality. Special Olympics is one of the largest non-profit organizations that focuses on the promotion of health and fitness for individuals with IDD (referred to as athletes) year-round. At the state level, Special Olympics South Dakota (SOSD) hosts an annual Summer Games where athletes are provided the opportunity to obtain free health screenings. If an area is identified as needing further attention, a referral is made for the athlete to obtain more in-depth care. The referral process often leads to difficulties for athletes, ranging from finding a healthcare provider (HCP) who is comfortable working with individuals with disabilities, to ensuring the acceptance of a wide range of health insurances (such as Medicaid). Obstacles to finding a HCP for a referral is what necessitates the need for a statewide HCP referral list. The purpose of this project is to increase the ease of accessibility to HCPs for individuals with IDD who are Special Olympics South Dakota athletes. METHODS: Data from Special Olympics and the CDC Disability and Health Data System (DHDS) was gathered to compare health outcomes between those with disabilities nationwide to those with disabilities in South Dakota. The referral list obtained HCPs via an online two-part survey. Survey 1 focused on demographic information on HCP and place of practice and Survey 2 focused on HCP training and professional work with those with IDD. The surveys were sent to individual providers via their respective professional state associations as well as through convenience sampling (relationship with Clinical Directors for SOSD). Survey 1 gathered 233 responses total, with 95 meeting completion criteria. Survey 2 offered to those 95 and gathered 66 responses total. RESULTS: Data on multiple health outcomes from the Special Olympics and CDC DHDS revealed individualized areas of concern with little overlap between the two datasets. Of the 95 HCPs added to the referral list (40% completion rate from Survey 1), the majority were localized to areas of higher population density in South Dakota (Sioux Falls and Rapid City areas). In Survey 2, 90% of HCPs indicated some level of training for working with individuals with IDD and 74% of responding HCPs were interested in obtaining further training. All HCPs that responded to Survey 2 had encounters with individuals with IDD in their current professional role, with 94% having 4 or more encounters. CONCLUSIONS: The Special Olympics South Dakota HCP referral list provides a direct method for SOSD athletes to find referral care. Currently, this is the only database of health care providers that is accessible to individuals with IDD that are members of SOSD. Geographically however, much of South Dakota is not represented on the current HCP referral list. While 90% of HCPs have training, 30% indicate not having received formal training on working with individuals with IDD during their professional training, also showcasing a need for HCPs to strive to limit potential gaps in care.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota Native American Population: A Descriptive Study.

OBJECTIVE: To describe the impact of multiple risk factors on stroke outcomes among Native Americans in South Dakota. METHODS: This is a retrospective chart review of 189 Native American patients treated for stroke in South Dakota between Jan. 1, 2016, to May 1, 2021 at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSION: These results align with previous studies that concluded many stroke risk factors are more prevalent among Native Americans in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in Native American populations to reduce risk for stroke with subsequent related disability or death.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota American Indian Population: A Descriptive Study.

INTRODUCTION: To describe the impact of multiple risk factors on stroke outcomes among American Indians in South Dakota. METHODS: This is a retrospective chart review of 189 American Indian patients treated for stroke in South Dakota between Jan 1, 2016, to May 1, 2021, at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSIONS: These results align with previous studies that concluded many stroke risk factors are more prevalent among American Indians in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in American Indian populations to reduce risk for stroke with subsequent related disability or death.

Burnout Among South Dakota-Licensed Physicians.

INTRODUCTION: Physician well-being is a topic of increasing attention nationwide. In collaboration with the South Dakota Board of Osteopathic and Medical Examiners and the South Dakota State Medical Association, we undertook an anonymous, web-based survey of all licensed physicians to assess the current baseline level of physician burnout. METHODS: The survey consisted of demographic questions and a single, validated burnout question that correlates with the lengthier Maslach Burnout Index. A link to take the survey was emailed to all licensees by the Board, and a single reminder email and link was sent two weeks later. The collector was open for 4 weeks from date of the initial invitation. Both quantitative and qualitative analyses were performed on the responses. RESULTS: There were 612 responses (10%). Overall 33.0% of responses were positive for burnout. Comparing subgroups divided by average work hours, practice size, community size, geographic location within the state, employment status, and specialty type, only those practicing primarily telemedicine demonstrated statistically significant lower prevalence of burnout (17%). Qualitative analysis identified themes that both increased risk and offered protection against burnout, including sense of control, availability of resources, relationships, and meaning in work. CONCLUSION: Burnout among physicians licensed by South Dakota is prevalent, though lower than the rate reported in most studies of physicians nationally. Apart from practicing primarily telemedicine, there was no correlation between burnout and practice characteristics, but provoking and palliating factors across practice types were identified that may offer potential areas for intervention to improve wellness.

Identifying the Use of Tanning Beds Among Undergraduate Students at South Dakota Universities and the Role of Providers: A Survey Analysis.

INTRODUCTION: Tanning bed use is common among young adults in the United States, and it contributes to over 400,000 cases of skin cancer annually. Many college students acknowledge the risk of skin cancer with tanning bed use, but this is not always a deterrent to the behavior. This study assesses the trends regarding tanning bed usage among university students and analyzes the role that primary care providers (PCPs) and dermatologists could play in reducing participation in this risky habit. METHODS: This study used a digital survey to assess the tanning bed usage trends and other aspects of skin health among undergraduate students at South Dakota universities. The survey was developed through interviews with dermatologists and public health professionals affiliated with the University of South Dakota. RESULTS: 321 students responded to the survey; 80% identified as female, 86% as Caucasian, and 93% were from the Midwest. 41% of respondents reported having previously used tanning beds. 46% of respondents reported never having seen a dermatologist for a skin check, and 42% indicated that their PCP does not perform a skin check during routine visits. When asked how a provider might influence participants to reconsider the use of tanning beds, responses included being presented statistics related to skin cancer and visualization of physical damage resulting from exposure to ultraviolet light. CONCLUSION: This study aims to better understand the prevalence of tanning bed usage among students at South Dakota universities. It also sought to better understand how providers can intervene to help reduce participation in this behavior. Given the risk associated with tanning bed exposure, our findings suggest that many students may be at increased risk of skin cancer from this behavior alone. This should encourage PCPs to consider incorporating skin checks into their examinations and provide preventative counseling recommendations to this population.

Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019-2020.

OBJECTIVES: This study assesses the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy. METHODS: This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. The relationship between ACEs and prescription opioid use during pregnancy is examined using multiple logistic regression. RESULTS: The prevalence of prescription opioid use increases alongside more ACE exposure. Compared to those with no ACEs, recent mothers with three or more ACEs have a 2.4 greater odds of prescription opioid use during pregnancy (aOR [adjusted odds ratio] = 2.437; 95% CI [confidence interval] = 1.319, 4.503). CONCLUSION: Exposure to three or more ACEs are associated with a higherrisk of prescription opioid use during pregnancy. Additional research is needed better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.

State of South Dakota's Child: 2022.

In 2021, South Dakota observed an increase in the number of births from 2020 when the state experienced its lowest historic birth rate. Nonetheless, this increase represented a 3.7 percent decrease from the state's previous five year (2016-2020) mean of live births. This growth in the 2021 cohort of newborns was seen almost entirely among its white population. Further, South Dakota's current rate of birth remains slightly higher than that observed nationally. Over recent years, the racial diversity of South Dakota's newborns became similar to that observed nation-wide with nearly one quarter being American Indian, Black or Other races (AIBO). This trended down in 2021 with 22 percent of the state's newborns AIBO. Further, in South Dakota, the percent of all AIBO newborns who are American Indian is decreasing. Currently, 60 percent of the AIBO population is American Indian compared to more than 90 percent in 1980. During the pandemic years of 2020 and 2021, racial disparities in perinatal outcome occurring during previous years continued to be observed but the onset of prenatal care in the first trimester for both white or AIBO pregnant women did not change. There were 71 infant deaths in 2021 yielding a decrease in South Dakota's infant mortality rate (IMR) from 7.4 to 6.3 (higher than the 5.4 IMR for 2020 for the U.S.). Though there was a decrease in the state's 2021 IMR to 6.3, the reduced rate from its previous five year mean of 6.5 is not statistically significant. The state's 2021 neonatal mortality rate (NMR = 0 to 27 days per 1,000 live births) and post neonatal mortality rate (PNMR=28 to 364 days per 1,000 live births) dropped for the white population and increased for the AIBO population, though the actual number of AIBO deaths associated with these rate increases were low. Between 2017- 2021, the South Dakota rates of death for AIBO compared to white newborns was significantly higher for perinatal causes, sudden unexpected death (SUID), and other causes. Compared to the U.S.' 2020 rates of infant mortality, South Dakota's comparable 2017-21 rates were significantly higher for congenital anomalies. In 2021 there were 15 deaths in the state due to SUID; a decrease from the previous year, yet little overall improvement in decreasing the rate of this cause of death has not been achieved. Between 2017 and 2021, SUIDs comprised 22 percent of infant deaths for both white and AIBO infants. A discussion of strategies to prevent these persisting tragedies is presented.

Myocarditis in Minnehaha County, South Dakota, 1880-1939.

From 1920 to 1940 in Minnehaha County there was an apparent striking increase in the incidence of fatal myocarditis and chronic myocarditis. Based on an analysis of the interment records of the Mt. Pleasant Cemetery, word frequency studies in two prominent American medical journals and a general review of related medical publications, we explore this increase. We conclude that there was no actual increase in the frequency of inflammatory disorders of the myocardium in Minnehaha County during this period. Rather, it appears that the use of the diagnostic terms was a matter of choice among local physicians that was not supported by contemporaneous clinical and pathophysiologic publications in available journals.

Fatal Accidental Drowning in Minnehaha County, South Dakota, 1880-1939.

Drowning is currently the second leading cause of injury-related death for children 1-4 years of age in the United States and is the leading cause of death worldwide for boys ages 5-14 years. The World Health Organization (WHO) classifies it as a public health threat and advocates for reducing drowning deaths by understanding geographical, cultural, and societal risk factors. To these three we added a fourth: historical studies. To that end, we analyzed accidental causes of death between January 1, 1880, and December 31, 1939, in Minnehaha County, South Dakota, based on interment records from the Mt. Pleasant Cemetery. From these six decades (1880-1939) of data, we classified 217 cases as accidental deaths. Drowning was the leading cause of accidental mortality, accounting for 50 accidental deaths (23%). Drowning deaths were analyzed by the decedents' age and date of death. We discuss specific historical drowning risk factors and hypothesize how they may have affected drowning deaths from 1880-1939 in Minnehaha County.

Telemedicine in the Wake of COVID-19: A Statewide Demographic Study on Provider Utilization and Perspective In South Dakota.

INTRODUCTION: The COVID-19 pandemic has ushered in a rapid evolution of regulations surrounding telemedicine and the public's need for affordable, accessible, high-quality care at a distance. This necessity led to a rise in telemedicine demand that forced health systems to adapt, and for providers to witness the potential benefits and limitations of such services. METHODS: In this analysis, Sanford Health EMR data was evaluated from Q2 of 2019 to Q2 of 2020 to compare specialty utilization of telemedicine and quantify percentage change within the midst of the COVID-19 pandemic. A survey was conducted to evaluate provider opinion within the Sanford Health system regarding demographics, usage, perceived benefits, and perceived barriers to this rapid adoption. RESULTS: Results suggest that Sanford Health experienced a significant, 1,600 percent increase of telemedicine usage. Additionally, with this increased usage of telemedicine, provider opinion of telemedicine and its potential has improved. During the pandemic, a greater percentage of providers believe telemedicine is highly beneficial to their practice and a majority believe telemedicine will continue to play a vital role in their practice in the future. However, the barriers found within the survey included limited patient access, technical difficulties, reimbursement, and insurance coverage. CONCLUSIONS: With the rapid increase in provider usage and the subsequent approval of providers, telemedicine has the potential to facilitate higher quality healthcare going forward. The COVID-19 pandemic has necessitated evolution and adoption of virtual media in medicine and has provided a unique glimpse into telemedicine's limitations and exceptional potential.

Experience Implementing a Public Health Surveillance System Designed for Fathers of Infants on a South Dakota American Indian Reservation.

INTRODUCTION: Paternal behaviors and attitudes during pregnancy are not known. A health survey for fathers of recently born infants was developed to be administered concurrently with a maternal survey to assess parental behaviors and attitudes before, during and after pregnancy. METHODS: Participants were parents of 149 American Indian infants born from April 1 and Dec. 31, 2015 who were recruited prospectively from data of all births in prespecified reservation counties representing Sisseton Wahpeton Oyate of the Lake Traverse Reservation. Data collection was via hard-copy or online survey. RESULTS: Response rate among mothers was 62 percent (n=92). Of 149 births, 126 listed a father on the birth certificate and 51 percent (n=64) of these completed surveys on average 4.7 months post-birth. Healthwise, 90 percent of fathers reported being overweight or obese, but a small percent visited a health care worker in the previous year to be checked for diabetes (11 percent) or hypertension (14 percent). Among fathers who smoked in the last two years (73 percent), 77 percent of the mothers also smoked compared to 20 percent of mothers smoking if the father did not smoke. Nearly three-fourths of fathers were supportive of breastfeeding (70 percent), and mothers whose partners were supportive were more likely to breastfeed than those with unsupportive partners (91 percent vs. 50 percent, respectively. The majority of fathers attended prenatal visits (57 percent), the delivery (88 percent), and some or all well-baby checks (73 percent) with the main barrier stated as not being able to take time off work. CONCLUSION: Conducting a health survey with both fathers and mothers in a reservation setting is feasible and the father's attitudes and behaviors related to breastfeeding and smoking were associated with maternal health behaviors. Most fathers attended health care visits with the mother, but they were not being screened for health conditions despite a large proportion being overweight and smokers. Prenatal and antenatal visits may provide an opportune time to engage fathers and address paternal health issues.

Late Surges in COVID-19 Cases and Varying Transmission Potential Partially Due to Public Health Policy Changes in 5 Western States, March 10, 2020, to January 10, 2021.

OBJECTIVE: This study investigates the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission potential in North Dakota, South Dakota, Montana, Wyoming, and Idaho from March 2020 through January 2021. METHODS: Time-varying reproduction numbers, R t , of a 7-d-sliding-window and of non-overlapping-windows between policy changes were estimated using the instantaneous reproduction number method. Linear regression was performed to evaluate if per-capita cumulative case-count varied across counties with different population size or density. RESULTS: The median 7-d-sliding-window R t estimates across the studied region varied between 1 and 1.25 during September through November 2020. Between November 13 and 18, R t was reduced by 14.71% (95% credible interval, CrI, [14.41%, 14.99%]) in North Dakota following a mask mandate; Idaho saw a 1.93% (95% CrI [1.87%, 1.99%]) reduction and Montana saw a 9.63% (95% CrI [9.26%, 9.98%]) reduction following the tightening of restrictions. High-population and high-density counties had higher per-capita cumulative case-count in North Dakota on June 30, August 31, October 31, and December 31, 2020. In Idaho, North Dakota, South Dakota, and Wyoming, there were positive correlations between population size and per-capita weekly incident case-count, adjusted for calendar time and social vulnerability index variables. CONCLUSIONS: R t decreased after mask mandate during the region's case-count spike suggested reduction in SARS-CoV-2 transmission.

State of South Dakota's Child: 2021.

The total number of 2020 resident births in South Dakota continues to decline with a 4 percent decrease from the previous year yielding the state's lowest crude birth rate (12.3 per 1,000 population) since its first recording in 1910. Currently, similar to the U.S., approximately one-quarter of all births are minority. The percentage of American Indian births is decreasing in its contribution to this population of the state with a growing percent of African American and multi-race newborns comprising the minority population in the state. South Dakota had one more infant death in 2020 (n=81) compared to 2019. The decrease in births led to a non-significant increase in the state's infant mortality rate (IMR) from 7.0 to 7.4 that is significantly higher than the U.S. rate (5.6) in 2019. An increase in nine sudden unexpected infant deaths (SUID) from 2019 to 2020 contributed to the rising IMR. Compared to the U.S., South Dakota has a lower percent of its infant deaths among those who are low birth weight (55 vs. 66 percent). Approximately one-third of white infant deaths occurred after the first 27 days of life; this was true for approximately half of all minority infants. Overall, South Dakota's minority infants have significantly higher rates of neonatal and post neonatal death than its whites, specifically due to perinatal causes, SUID, and accidents/homicide. How SUID contributes to the state's IMR is an area for needed attention as these deaths are increasingly known to accompany risks that, if alleviated, could prevent loss of early life. An examination of data from the year 2020 is the first opportunity to see possible relationships between perinatal outcomes and the pandemic that spanned approximately three-quarters of this year. Drawing causal relationships is not possible, but several observations about the impact of the pandemic are made as natality and infant mortality data for this year are explored in this annual report.

Spillover of Canine Parvovirus Type 2 to Pigs, South Dakota, USA, 2020.

In 1978, canine parvovirus type 2 originated from spillover of a feline panleukopenia-like virus, causing a worldwide pandemic of enteritis and myocarditis among canids. In 2020, the virus was identified in pigs in South Dakota, USA, by PCR, sequencing, in situ hybridization, and serology. Genetic analysis suggests spillover from wildlife.