Measles Outbreak Associated with a Migrant Shelter - Chicago, Illinois, February-May 2024.

Measles, a highly contagious respiratory virus with the potential to cause severe complications, hospitalization, and death, was declared eliminated from the United States in 2000; however, with ongoing global transmission, infections in the United States still occur. On March 7, 2024, the Chicago Department of Public Health (CDPH) confirmed a case of measles in a male aged 1 year residing in a temporary shelter for migrants in Chicago. Given the congregate nature of the setting, high transmissibility of measles, and low measles vaccination coverage among shelter residents, measles virus had the potential to spread rapidly among approximately 2,100 presumed exposed shelter residents. CDPH immediately instituted outbreak investigation and response activities in collaboration with state and local health departments, health care facilities, city agencies, and shelters. On March 8, CDPH implemented active case-finding and coordinated a mass vaccination campaign at the affected shelter (shelter A), including vaccinating 882 residents and verifying previous vaccination for 784 residents over 3 days. These activities resulted in 93% measles vaccination coverage (defined as receipt of ≥1 recorded measles vaccine dose) by March 11. By May 13, a total of 57 confirmed measles cases associated with residing in or having contact with persons from shelter A had been reported. Most cases (41; 72%) were among persons who did not have documentation of measles vaccination and were considered unvaccinated. In addition, 16 cases of measles occurred among persons who had received ≥1 measles vaccine dose ≥21 days before first known exposure. This outbreak underscores the need to ensure high vaccination coverage among communities residing in congregate settings.

Long-term effects of a community-based positive youth development program for Black youth: health, education, and financial well-being in adulthood.

BACKGROUND: Childhood poverty is known to be associated with poor health. For youth living in extreme poverty, community-based programs focused on youth development are one strategy to improve health and well-being outcomes. However, very few evaluations of the long-term effectiveness of youth development programs have been conducted. The aim of this study was to assess the long-term effectiveness of a positive youth development program (PYD), serving a segregated housing project with a history of community violence, to improve the health, education, and financial well-being of its alumni. METHODS: A quasi-experimental causal comparative study design was used to study the effectiveness of the Cabrini-Green Youth Program (CGYP). CGYP alumni (mean: 16.8 +/- 7.4 years after program participation) were surveyed. For comparison, participants from the same housing project who were eligible to participate in the CGYP but did not, were identified. RESULTS: In total, 246/417 (59%) eligible alumni were located. 221 alumni were available to be interviewed; 191/221 (86%) completed the interview survey along with 143 in the comparison group. Both groups self-identified as being Black, African American, and of Other race. Alumni were younger (34.6 vs. 38.1 years, p < .001), less likely to be female (62% vs. 74%, p =.03), and more likely to have been abused as a child (26% vs. 11%, p = .001). The majority in both groups reported to be in good to excellent health (83% of alumni vs. 74% of comparison group). After adjusting for comparison group differences, alumni were more likely to have completed college, 24% vs. 12% (adjusted odds ratio (aOR) 2.47, 95% CI, 1.25-4.86), and to end up with some money at the end of the month, 35% vs. 19% (aOR 2.16, 95% CI, 1.17, 3.97). CONCLUSIONS: Participation in a PYD program starting at a young age may be associated with reduced poverty in adulthood, possibly aided by higher educational attainment and resultant increased income. PYD may be an effective strategy to supplement evidenced-based poverty reducing policies. This study of a voluntary, community-based PYD program is unique in its up to 33-year follow-up and an outcome assessment that measures more than knowledge change.

Comparing the Risk of Sudden Unexpected Infant Death to Common Causes of Childhood Injury Death.

In a secondary analysis of publicly available data, the rate of sudden unexplained infant death in the first year exceeded the peak rates of the leading causes of injury death for youth (≤19 years of age). The absolute risk of sudden unexplained infant death exceeded age-specific risks of the major causes of child injury mortality regardless of race or ethnicity.

Attitudes and Counseling Practices of Pediatricians Regarding Youth Sports Participation and Concussion Risks.

OBJECTIVE: To examine attitudes and practices of pediatricians toward sports-related head trauma and youth participation in tackle football and ice hockey. STUDY DESIGN: A respondent-anonymous electronic survey was distributed 3 times to members of the American Academy of Pediatrics Section of Bioethics, Council on Injury, Violence, and Poison Prevention, and Council on Sports Medicine and Fitness. RESULTS: Of 791 eligible pediatricians, 227 (29%) responded. Most respondents (189/223; 85%) treat sports-related concussions, among whom 83% (137/165) reported access to an established return-to-play protocol within their practice. Virtually all (160/166; 96%) reported increased parental awareness/concern regarding concussions and 85% (139/163) reported increased visits for head trauma. Overall, 77% (140/183) would not allow their son to play tackle football and 35% (64/181) and 34% (63/184) would not allow their son or daughter, respectively, to participate in ice hockey. Most respondents endorsed limiting or eliminating tackling (143/176; 81%) and checking (144/179; 80%) from practice. Respondents were evenly divided in their support for counseling against youth participation in full-contact sports, with 48% in favor (87/180). CONCLUSIONS: Most respondents would not allow their own child to play tackle football and endorsed limiting or eliminating tackling in practice. The American Academy of Pediatrics should consider recommending restrictions on tackling in football to support the current concussion concerns of its members.

Child Fatality Review.

Understanding why children die is necessary to implement strategies to prevent future deaths and improve the health of any community. Child fatality review teams (CFRTs) have existed since the 1970s and provide a necessary framework to ensure that proper questions are asked about a child's death. CFRTs provide a vital function in a community to ensure that preventable causes of deaths are identified. Pediatricians are necessary members of CFRTs because they provide medical expertise and context around a child's death. All CFRTs should have pediatric physician representation, and results from team meetings should inform public policy at all levels of government. Pediatricians should be supported in their efforts to be present on CFRTs, and they should use data from team meetings to help advocate for implementing prevention strategies.

Racial and ethnic disparities of sudden unexpected infant death in large US cities: a descriptive epidemiological study.

BACKGROUND: Sudden unexpected infant death (SUID) accounts for ~ 3400 deaths per year in the USA, and minimal progress has been made in reducing SUID over the past two decades. SUID is the sudden death of an infant that has occurred as a result of accidental suffocation in a sleeping environment, SIDS (sudden infant death syndrome), or from an unknown cause of death. Nationally, non-Hispanic Black (NHB) infants have twice the risk of SUID compared to non-Hispanic White (NHW) infants. In Chicago, this disparity is greatly magnified. To explore whether this disparity is similarly seen in other large cities, we analyzed SUIDs by race and ethnicity for a seven-year period from the 10 most populous US cities. SUID case counts by race and ethnicity were obtained for 2011-2017 from the 10 most populous US cities based on 2010 census data. For each city, we calculated average annual SUID rates (per 1000 live births) by race and ethnicity, allowing calculation of disparity rate ratios. FINDINGS: Nationally, from 2011 through 2017, there were 0.891 SUIDs per 1000 live births, with a rate of 0.847 for NHWs, 1.795 for NHBs, and 0.522 for Hispanics. In most study cities, the NHB and Hispanic SUID rates were higher than the corresponding national rate. Hispanic SUID rates were higher than NHW rates in 9 of the 10 largest cities. In every study city, the NHW SUID rate was lower than the national NHW rate. In Chicago, NHB infants had a SUID rate 12.735 times that of NHW infants. CONCLUSION: With few exceptions, the 10 largest US cities had higher NHB and Hispanic SUID rates, but lower NHW SUID rates, compared to the corresponding rates at the national level. Unlike the national pattern, Hispanic SUID rates were higher than NHW rates in 9 of the 10 largest cities. Prevention is currently hampered by the lack of detailed, accurate, and timely information regarding the circumstances of these tragic deaths. A national SUID surveillance system would allow greater understanding of the factors that lead to this disproportionately distributed and enduring cause of infant death.

American Academy of Pediatrics Recommendations for the Prevention of Pediatric ATV-Related Deaths and Injuries.

Since all-terrain vehicles (ATVs) were introduced in the mid-1970s, regulatory agencies, injury prevention researchers, and pediatricians have documented their dangers to youth. Major risk factors, crash mechanisms, and injury patterns for children and adolescents have been well characterized. Despite this knowledge, preventing pediatric ATV-related deaths and injuries has proven difficult and has had limited success. This policy statement broadly summarizes key background information and provides detailed recommendations based on best practices. These recommendations are designed to provide all stakeholders with strategies that can be used to reduce the number of pediatric deaths and injuries resulting from youth riding on ATVs.

Targeting pediatric pedestrian injury prevention efforts: teasing the information through spatial analysis.

BACKGROUND: Pediatric pedestrian injuries remain a major cause of childhood death, hospitalization, and disability. To target injury prevention efforts, it is imperative to identify those children at risk. Racial disparities have been noted in the rates of pediatric pedestrian injury and death. Children from low-income families living in dense, urban residential neighborhoods have a higher risk of sustaining pedestrian injury. Geographic information systems (GIS) analysis of associated community factors such as child population density and median income may offer insights into prevention. METHODS: Using trauma registry E-codes for pedestrian motor vehicle crashes, children younger than 16 years were identified, who received acute care and were hospitalized at the University of Chicago Medical Center, a Level I pediatric trauma center, after being struck by a motor vehicle from 2002 to 2009. By retrospective chart review and review of the Emergency Medical Services run sheets, demographic data and details of the crash site were collected. Crash sites were aggregated on a block by block basis. A "hot spot" analysis was performed to localize clusters of injury events. Using Gi* statistical method, spatial clusters were identified at different confidence intervals using a fixed distance band of 400 m (≈ » mile). Maps were generated using GIS with 2000 census data to evaluate race, employment, income, density of public and private schools, and density of children living in the neighborhoods surrounding our medical center where crash sites were identified. Spatial correlation is used to identify statistically significant locations. RESULTS: There were 3,521 children admitted to the University of Chicago Medical Center for traumatic injuries from 2002 to 2009; 27.7% (974) of these children sustained injuries in pedestrian motor vehicle injuries. From 2002 to 2009, there were a total of 106 traumatic deaths, of which 29 (27.4%) were due to pedestrian motor vehicle crashes. Pediatric pedestrian motor vehicle crash sites occurred predominantly within low-income, predominantly African-American neighborhoods. A lower prevalence of crash sites was observed in the predominantly higher income, non-African-American neighborhoods. CONCLUSIONS: Spatial analysis using GIS identified associations between pediatric pedestrian motor vehicle crash sites and the neighborhoods served by our pediatric trauma center. Pediatric pedestrian motor vehicle crash sites occurred predominantly within low-income, African-American neighborhoods. The disparity in prevalence of crash sites is somewhat attributable to the lower density of children living in the predominantly higher income, non-African-American neighborhoods, including the community immediately around our hospital. Traffic volume patterns, as a denominator of these injury events, remain to be studied.

Behaviors of young children around microwave ovens.

BACKGROUND: Scald burn injuries are the leading cause of burn-related emergency room visits and hospitalizations for young children. A portion of these injuries occur when children are removing items from microwave ovens. This study assessed the ability of typically developing children aged 15 months to 5 years to operate, open, and remove the contents from a microwave oven. METHODS: The Denver Developmental Screening Test II was administered to confirm typical development of the 40 subjects recruited. All children recruited and enrolled in this study showed no developmental delays in any domain in the Denver Developmental Screening Test II. Children were observed for the ability to open both a push and pull microwave oven door, to start the microwave oven, and to remove a cup from the microwave oven. RESULTS: All children aged 4 years were able to open the microwaves, turn on the microwave, and remove the contents. Of the children aged 3 years, 87.5% were able to perform all study tasks. For children aged 2 years, 90% were able to open both microwaves, turn on the microwave, and remove the contents. In this study, children as young as 17 months could start a microwave oven, open the door, and remove the contents putting them at significant risk for scald burn injury. CONCLUSIONS: Prevention efforts to improve supervision and caregiver education have not lead to a significant reduction in scald injuries in young children. A redesign of microwave ovens might prevent young children from being able to open them thereby reducing risk of scald injury by this mechanism.

A firm recommendation: measuring the softness of infant sleep surfaces.

BACKGROUND: Approximately 3600 sudden unexpected infant deaths (SUID) occur annually in the United States, and a quarter of SUIDs are caused by unintentional suffocation and strangulation in bed, with soft bedding use being a significant risk factor. Therefore, The American Academy of Pediatrics (AAP) recommends infants sleep on a "firm" surface, though neither an objective definition nor national standard has been established. The purpose of this study is to report on the performance of a device that measures mattress softness and to provide quantitative values of softness for various infant sleep surfaces. METHODS: In collaboration with the authors and a national child product safety organization (Kids in Danger), University of Michigan engineering students designed and validated a device that measures the vertical depression (softness) of a simulated 2-month-old's head on a sleep surface. A total of 17 infant sleep surfaces - 14 household surfaces and 3 hospital mattresses - were measured between April 2019 and January 2020. The average softness of each surface was calculated. Surfaces were also measured with soft bedding, which included an infant fleece blanket, and firm and soft pillows. RESULTS: The average softness for the 14 household sleep surfaces ranged from 7.4-36.9 mm. The 2019 cribette playard and the 2018 infant spring had similar softness (21 mm) as the 2018 and 2019 adult foam and 2015 sofa. An infant's fleece blanket folded once added an additional 2.3-6.5 mm of softness, folded twice added 4.8-11.6 mm, and folded three times added 11-21.8 mm. Using a firm pillow added 4.0-20.9 mm of softness while using a soft pillow added 24.5-46.4 mm. The softness for the 3 hospital sleep surfaces ranged from 14 to 36.9 mm, with the infant bassinet being the firmest and the pediatrics mattress being the softest. CONCLUSIONS: We found a wide range of softness among sleep surfaces, with some infant mattresses as soft as some adult mattresses. Adding blankets and pillows to mattresses measurably increased softness. Quantifying sleep surface softness will advance our understanding of how softness relates to SUID risk. We hope this new information will further inform safe infant sleep recommendations and improve mattress safety standards nationally.

Making Microwave Oven Doors Child Resistant to Protect Young Children From Severe Scalds.

Most severe child scalds in the United States involve food and beverages. The wide variety of burn mechanisms, however, makes prevention challenging. Over the past 15 years, we have worked toward protecting young children from 1 specific mechanism: children opening microwave oven doors themselves and spilling the heated contents, resulting in often severe scalds. In our published research, we documented the frequency and severity of these cases and the vulnerability of young toddlers to be burned in this way. We have presented our findings and ideas for prevention at multiple national meetings and enlisted college engineering students to design microwave doors that would thwart a young child from opening them. In 2017, we became active members of a national task group convened by Underwriters Laboratories to address this issue, and two authors became voting members on the Underwriters Laboratories Standards Technical Panel for microwave ovens. We worked with microwave manufacturers and others for >1 year to address concerns of the industry, including those related to potential impacts on older adults. This effort resulted in the task group proposing a change in the standard, requiring "two distinct actions" to open the door of a microwave oven. On September 17, 2018, the panel voted to pass the measure, which will require child-resistant doors for all new microwave ovens in 2023. This report highlights how research can inform and support child injury prevention advocacy. Children will now be protected from this type of scald as microwaves with child-resistant doors replace current models.

Factors Associated With Unrestrained Young Passengers in Motor Vehicle Crashes.

: media-1vid110.1542/5984244682001PEDS-VA_2018-2507Video Abstract BACKGROUND AND OBJECTIVE: Unrestrained child passengers are at significant risk of crash-related injury. Previous researchers using nationally representative crash data from 1992 to 1993 found an association between driver and passenger safety-belt use. Our objective in this study is to investigate factors associated with young, unrestrained passengers in fatal and nonfatal motor vehicle crashes using updated national crash data. METHODS: We analyzed 2011-2015 Fatality Analysis Reporting System and National Automotive Sampling System data and included vehicles with a young passenger (≤19 years old) in a crash. Driver and passenger characteristics were compared by using bivariate analyses separately for fatal and nonfatal crashes. Logistic regression analyses were performed on a combined data set to predict passenger restraint use. RESULTS: In unadjusted bivariate models, unrestrained drivers had a higher probability of having an unrestrained passenger across all passenger age groups for both fatal and nonfatal crashes. In multivariate logistic regression models that included both fatal and nonfatal crashes and were adjusted for several driver and passenger characteristics, unrestrained drivers had a higher risk of having an unrestrained young passenger across all age groups. CONCLUSIONS: In both fatal and nonfatal crashes, a driver being unrestrained is a strong predictor of the child passenger also being unrestrained. Policy and regulation to better ensure that drivers are properly restrained (eg, expanding primary seat-belt laws to all states) may serve as effective means for increasing rates of proper child-occupant-restraint use.

Outcomes after injury prevention counselling in a paediatric office setting: a 25-year review.

OBJECTIVE: Injury is the leading cause of death and acquired disability in children. Primary care providers routinely provide age-appropriate injury prevention (IP) counselling during healthcare visits. The objective was to review evaluations of the effectiveness of office-based paediatric IP counselling research. DESIGN: This review identified studies from July 1991 to June 2016 of children <5 years and their caretakers to determine the effectiveness of office-based counselling on IP knowledge, behaviours and outcomes. Studies were included if they had: (1) an intervention for a family with a child <5 years of age; (2) an unintentional injury mechanism addressed during counselling; (3) one or more mechanisms recommended to be discussed for children <5 years in the 2007American Academy of Pediatrics Policy Statement; (4) counselling occurring in the office setting; (5) an assessment of an outcome (eg, change in knowledge, behaviour or injury occurrences); and (6) English-language publication. Study characteristics (whether the study was controlled, randomised and/or blinded), target safety behaviours, the sample size, outcomes assessed (injuries, behaviour changes and/or education changes) and demonstrated effects were summarised. RESULTS: Sixteen articles met inclusion criteria. Twelve articles were randomised controlled trials, three were non-randomised trials and one was a pretest and post-test study. Fourteen articles measured a change in knowledge or reported behaviour, four included observed behaviour change and five measured change in injury outcomes. Thirteen of the 16 studies had positive effects demonstrated for certain outcomes, including for fall, poisoning, burn, fire, traffic injury and drowning prevention, while 10 showed no differences between study groups for other outcomes. CONCLUSIONS: Published outcomes-based IP-related counselling research in the primary care setting for young children is infrequent, and additional research is necessary to further describe the effectiveness of these primary prevention efforts.

You can have your breastmilk and safe sleep too: a preliminary analysis of infant safe sleep data in a Midwestern home visiting program.

BACKGROUND: Sudden unexpected infant death (SUID) accounted for approximately 3700 infant deaths in the US in 2015. SUID risk factors include prone sleeping, bed-sharing, soft bedding use, and maternal smoking. Infant safe sleep data in at-risk communities are difficult to obtain and home visiting programs can add to what we know. This study's purpose is to determine how often caregivers enrolled in home visiting programs provide safe sleep environments for their infants in relation to breastfeeding status and tobacco use. METHODS: Female caregivers in at-risk communities were prospectively enrolled in Midwestern home visiting programs. Those that had infants < 365 days old and completed a safe sleep survey between October 1, 2016 and May 18, 2017 were included. Caregivers' responses (always, sometimes, or never) to three safe sleep questions were compared by breastfeeding status, caregiver tobacco use, and household tobacco use using Pearson's chi-squared or Fisher's exact test. RESULTS: The characteristics of the 289 eligible female caregivers included 120 (42%) ≤ 21 years old, 137 (47%) black, 77 (27%) breastfeeding, and 60 (22%) with household tobacco use. Two hundred forty-six (85%) caregivers always placed infants in the supine position, 148 (51%) never bed-shared, and 186 (64%) never used soft bedding. Ongoing breastfeeding caregivers never bed-shared more often than those who never breastfed or weaned (66% vs. 53% vs. 39%, p = 0.003). Households with tobacco use placed infants in the supine position less (75% vs. 88%, p = 0.03), bed-shared more (62% vs. 44%, p = 0.04), and used soft bedding more (50% vs. 32%, p = 0.004) relative to those without tobacco use. CONCLUSIONS: In this group of at-risk young mothers, those who breastfed bed-shared less than mothers who were not breastfeeding; this finding has implications toward reducing the SUID risk in similar populations. This study also demonstrated that infants living with a tobacco user are less likely to be sleeping safely. This suggests that a multifaceted approach to safe sleep counseling may be needed.

Types of Objects in the Sleep Environment Associated With Infant Suffocation and Strangulation.

OBJECTIVE: To investigate the circumstances of death and types and roles of objects present in the sleep environment at the time of death for infants who died from suffocation or strangulation during sleep. METHODS: This study analyzed 1736 reported incidents of accidental suffocation and strangulation in bed (ASSB) of infants younger than 1 year of age. These fatalities occurred from 2000 through 2012 and were reported to the United States Consumer Product Safety Commission. RESULTS: The mean age of ASSB death was 3.76 months (SD, 2.51). Infants younger than 5 months accounted for 67.3% (1168 of 1736) of all reported fatalities and 58.3% (1009 of 1731) were male. Deceased infants were often found in a crib or bassinet (30.6%; 383 of 1253) or in the prone orientation (84.9%; 595 of 701). The most common objects associated with infant ASSB were pillows (24.5%; 425 of 1736), mattresses (21.0%; 364 of 1736), blankets (13.1%; 228 of 1736), and walls (11.5%; 199 of 1736). Wedged (43.3%; 616 of 1424) or positioned on top of an object (25.9%; 369 of 1424) were the most common positions associated with death. Infants were often found wedged between a mattress and wall (30.2%; 181 of 599) or oriented face-down or prone on top of a pillow (52.2%; 187 of 358). Sleep surface sharing was associated with 6.5% (112 of 1736) of ASSB deaths. CONCLUSIONS: Pillows and blankets are objects in sleep environments frequently associated with unintentional suffocation and strangulation of infants. Increased efforts should be made to remove these and other objects from sleep environments of infants.

Epidemic diarrhea due to enterotoxigenic Escherichia coli.

BACKGROUND: In June 1998, we investigated one of the largest foodborne outbreaks of enterotoxigenic Escherichia coli gastroenteritis reported in the United States. METHODS: We conducted cohort studies of 11 catered events to determine risk factors for illness. We used stool cultures, polymerase chain reaction, and serologic tests to determine the etiologic agent, and we conducted an environmental inspection to identify predisposing conditions and practices at the implicated establishment. RESULTS: During 5-7 June, the implicated delicatessen catered 539 events attended by >16,000 people. Our epidemiological study of 11 events included a total of 612 attendees. By applying the median prevalence of illness (20%) among events with ill attendees to the total number of events with any ill attendees, we estimate that at least 3300 persons may have developed gastroenteritis during this outbreak. Multiple food items (potato salad, macaroni salad, egg salad, and watermelon) were associated with illness, all of which required extensive handling during preparation. Enterotoxigenic Escherichia coli serotype O6:H16 producing heat-labile and heat-stable toxins was isolated from the stool specimens from 11 patients. Eight patients with positive stool culture results, 11 (58%) of 19 other symptomatic attendees, and 0 (0%) of 17 control subjects had elevated serum antibody titers to E. coli O6 lipopolysaccharide. The delicatessen had inadequate hand-washing supplies, inadequate protection against back siphonage of wastewater in the potable water system, a poorly draining kitchen sink, and improper food storage and transportation practices. CONCLUSIONS: In the United States, where enterotoxigenic Escherichia coli is an emerging cause of foodborne disease, enterotoxigenic Escherichia coli should be suspected in outbreaks of gastroenteritis when common bacterial or viral enteric pathogens are not identified.