Implications of Measles Inclusion by Commercial Syndromic Polymerase Chain Reaction Panels - United States, May 2022-April 2023.

Syndromic polymerase chain reaction (PCR) panels are used to test for pathogens that can cause rash illnesses, including measles. Rash illnesses have infectious and noninfectious causes, and approximately 5% of persons experience a rash 7-10 days after receipt of a measles, mumps, and rubella (MMR) vaccine. MMR vaccine includes live attenuated measles virus, which is detectable by PCR tests. No evidence exists of person-to-person transmission of measles vaccine virus, and illness does not typically result among immunocompetent persons. During September 2022-January 2023, the Tennessee Department of Health received two reports of measles detected by syndromic PCR panels. Both reports involved children (aged 1 and 6 years) without known risk factors for measles, who were evaluated for rash that occurred 11-13 days after routine MMR vaccination. After public health responses in Tennessee determined that both PCR panels had detected measles vaccine virus, six state health departments collaborated to assess the frequency and characteristics of persons receiving a positive measles PCR panel test result in the United States. Information was retrospectively collected from a commercial laboratory testing for measles in syndromic multiplex PCR panels. During May 2022-April 2023, among 1,548 syndromic PCR panels, 17 (1.1%) returned positive test results for measles virus. Among 14 persons who received a positive test result and for whom vaccination and case investigation information were available, all had received MMR vaccine a median of 12 days before specimen collection, and none had known risk factors for acquiring measles. All positive PCR results were attributed to detection of measles vaccine virus. Increased awareness among health care providers about potential measles detection by PCR after vaccination is needed. Any detection of measles virus by syndromic PCR testing should be immediately reported to public health agencies, which can use measles vaccination history and assessment of risk factors to determine the appropriate public health response. If a person recently received MMR vaccine and has no risk factors for acquiring measles, additional public health response is likely unnecessary.

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.

Validation of a new acoustic telemetry transmitter for the study of predation events in small fishes.

Acoustic telemetry has emerged as an important tool for studying the movement and behavior of aquatic animals. Predation-sensing acoustic transmitters combine the functions of typical acoustic transmitters with the added ability to identify the predation of tagged animals. The objective of this paper was to assess the performance of a newly miniaturized acid-based predation-sensing acoustic transmitter (Innovasea V3D; 0.33 g in air). We conducted staged predation events in the laboratory where acoustically tagged rainbow trout (Oncorhynchus mykiss) were fed to largemouth bass (Micropterus nigricans) at 3.3-7.0, 9.0-10.8, 16.0-20.0, and 22.0-25.8°C. We also conducted false-positive tests where tagged rainbow trout were held at 10.0 and 16.8°C without the risk of predation. Predation events were successfully identified in 92% of the staged predation trials. Signal lag (i.e., the time required for a predation tag to indicate that predation occurred) ranged from 0.11 to 6.29 days and decreased strongly with increasing water temperature and increased with increasing body mass of the tagged prey. Tag retention in the gut of the predator was much more variable than signal lag and was influenced by water temperature and individual predators but not by prey mass. No false positives were detected after 60 days at either temperature (n = 27 individuals). Although the relationships between water temperature, signal lag, and retention time are likely species-specific, the data reported here provide useful information for the use of these transmitters to study predation in wild fishes, especially for temperate, freshwater fish.

Multimodal imaging of drug and excipients in rat lungs following an inhaled administration of controlled-release drug laden PLGA microparticles.

Controlled-release formulations, in the form of micro- or nanoparticles, are increasingly attractive to the pharmaceutical industry for drug delivery. For respiratory illnesses, controlled-release microparticle formulations provide an opportunity to deliver a higher percentage of an inhaled medicament dose to the lung, thus potentially reducing the therapeutic dose, frequency of dosing, and minimising side-effects. We describe the use of a multimodal approach consisting of MALDI MS imaging, 3D depth profiling TOF-SIMS analysis, and histopathology to monitor the distribution of drug and excipients in sections taken from excised rat lungs following an inhaled administration of drug-laden microparticles. Following a single dose, the administered drug was detected in the lung via both MALDI MS and TOF-SIMS over a range of time points. Both imaging techniques enabled the characterisation of the distribution and retention of drug particles and identified differences in the capabilities of both imaging modalities. Histochemical staining of consecutive sections was used to provide biological context to the findings and will also be discussed in this presentation. We demonstrate how this multimodal approach could be used to help increase our understanding of the use of controlled release microparticles.

COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020.

In April 2020, during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Europe, a cluster of children with hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome was reported in England* (1). The patients' signs and symptoms were temporally associated with COVID-19 but presumed to have developed 2-4 weeks after acute COVID-19; all children had serologic evidence of infection with SARS-CoV-2, the virus that causes COVID-19 (1). The clinical signs and symptoms present in this first cluster included fever, rash, conjunctivitis, peripheral edema, gastrointestinal symptoms, shock, and elevated markers of inflammation and cardiac damage (1). On May 14, 2020, CDC published an online Health Advisory that summarized the manifestations of reported multisystem inflammatory syndrome in children (MIS-C), outlined a case definition,† and asked clinicians to report suspected U.S. cases to local and state health departments. As of July 29, a total of 570 U.S. MIS-C patients who met the case definition had been reported to CDC. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results. The remaining 367 (64.4%) of MIS-C patients had manifestations that appeared to overlap with acute COVID-19 (2-4), had a less severe clinical course, or had features of Kawasaki disease.§ Median duration of hospitalization was 6 days; 364 patients (63.9%) required care in an intensive care unit (ICU), and 10 patients (1.8%) died. As the COVID-19 pandemic continues to expand in many jurisdictions, clinicians should be aware of the signs and symptoms of MIS-C and report suspected cases to their state or local health departments; analysis of reported cases can enhance understanding of MIS-C and improve characterization of the illness for early detection and treatment.

SARS-CoV-2-Associated Deaths Among Persons Aged <21 Years - United States, February 12-July 31, 2020.

Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2-associated deaths reported to CDC among persons aged <21 years in the United States during February 12-July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1-9 years, 70% were aged 10-20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED).† These data show that nearly three quarters of SARS-CoV-2-associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10-20 years, with a disproportionate percentage among young adults aged 18-20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 infections, deaths, and other severe outcomes among persons aged <21 years remains particularly important as schools reopen in the United States. Ongoing evaluation of effectiveness of prevention and control strategies will also be important to inform public health guidance for schools and parents and other caregivers.

Assessing baloxavir susceptibility of influenza viruses circulating in the United States during the 2016/17 and 2017/18 seasons.

The anti-influenza therapeutic baloxavir targets cap-dependent endonuclease activity of polymerase acidic (PA) protein. We monitored baloxavir susceptibility in the United States with next generation sequencing analysis supplemented by phenotypic one-cycle infection assay. Analysis of PA sequences of 6,891 influenza A and B viruses collected during 2016/17 and 2017/18 seasons showed amino acid substitutions: I38L (two A(H1N1)pdm09 viruses), E23G (two A(H1N1)pdm09 viruses) and I38M (one A(H3N2) virus); conferring 4-10-fold reduced susceptibility to baloxavir.

Mumps Outbreak at a University and Recommendation for a Third Dose of Measles-Mumps-Rubella Vaccine - Illinois, 2015-2016.

Mumps is an acute viral disease characterized by fever and swelling of the parotid or other salivary glands. On May 1, 2015, the Illinois Department of Public Health (IDPH) confirmed a mumps outbreak at the University of Illinois at Urbana-Champaign. IDPH and the Champaign-Urbana Public Health District (C-UPHD) conducted an investigation and identified 317 cases of mumps during April 2015-May 2016. Because of sustained transmission in a population with high 2-dose coverage with measles-mumps-rubella (MMR) vaccine, a third MMR dose was recommended by IDPH, C-UPHD, and the university's McKinley Health Center. No formal recommendation for or against the use of a third MMR dose has been issued by the Advisory Committee on Immunization Practices (ACIP) (1). However, CDC has provided guidelines for use of a third dose as a control measure during mumps outbreaks in settings in which persons are in close contact with one another, where transmission is sustained despite high 2-dose MMR coverage, and when traditional control measures fail to slow transmission (2).

State of polycyclic aromatic hydrocarbon (PAH) contamination in the Saint John Harbour, New Brunswick, Canada.

This study examined the concentrations and compositions of polycyclic aromatic hydrocarbon (PAH) contaminants in the surficial sediments of the Saint John Harbour (SJH) and assessed PAH exposure to local aquatic biota. Our findings suggest that sedimentary PAH contamination is heterogeneous and widespread in the SJH, with several sites exceeding the Canadian and NOAA recommended guidelines for the protection of aquatic life. Despite high concentrations of PAHs at some sites, there was no indication that local nekton was affected. Lack of a biological response may be due in part to a low bioavailability of sedimentary PAHs, presence of confounding factors (e.g., trace metals), and/or adaptation of local wildlife to the historic PAH contamination in this region. Overall, although no indication of effects to wildlife was observed with the data collected in the present study, continued efforts should be made to remediate highly contaminated areas and reduce the prevalence of these compounds.

Dental hygiene student attitudes about benefits of baccalaureate degree and factors impacting entry-level program choice.

PURPOSE/OBJECTIVES: Although the bachelor's degree is the entry-level degree option supported by the American Dental Hygienists' Association, the majority of dental hygiene programs remain associate degree. The aim of this study was to explore factors impacting entry-level program choice and examine attitudes and perceptions of dental hygiene students pertaining to a bachelor's degree (BS) as the entry-level degree. METHODS: A cross-sectional survey research design was utilized with a convenience sample of dental hygiene students (n = 429) from the United States and Canada. The 33-item survey had four sections: demographics, factors influencing program choice, attitudes, and perceptions of a BS. Descriptive and inferential analysis was used to explore the relationship between variables. RESULTS: The completion rate was 91% (n = 384). Factors that most influenced program choice included: location (74%), cost (68%), and time to completion (47.7%). Students with mothers who graduated from college were more likely to rank time to completion as their number one factor (37%) (χ2[df2] = 19.6, p < 0.001, phi = 0.33). Students in bachelor's programs were significantly more likely to believe a bachelor's degree better prepared clinicians for duties required in future practice and that the entry-level degree should be raised to a bachelor's degree (p < 0.001). While more students in associate degree program agreed there were opportunities in education without a bachelor's degree (p < 0.05). CONCLUSION: Cost, time to completion, and location were the factors influencing students' program choice. While the dental hygiene profession advocates raising the entry-level degree to a bachelor's programs, less than 40% of dental hygiene students supported this change.

Exploration of the Experience of Care Home Managers of COVID-19 Vaccination Programme Implementation and Uptake by Residents and Staff in Care Homes in Northern Ireland.

The Coronavirus 2019 (COVID-19) pandemic disproportionately affected people living and working in care homes. This study aimed to explore the experience of care home managers on the implementation and uptake of the COVID-19 vaccination programme by residents and staff in care homes in Northern Ireland. An exploratory mixed methods approach was used, i.e., semi-structured interviews to design the cross-sectional survey and content analysis of statements using open ended questions. Care home managers were approached and sixty-seven valid quantitative and forty-nine descriptive responses were analysed. The study identified eight themes which described factors that motivated residents (family visits and relationship with managers and staff), and staff vaccine uptake (return to normal life at work and trust in care home managers). The identified themes also confirmed that vaccine uptake is negatively influenced by perceived side effects. The findings indicated that social media can promote or decelerate the uptake of vaccine despite the accessibility to a successful vaccination programme. The study highlights the important role of managers in handling the challenges through building trust and establishing relationships with staff and residents. The findings identified challenges to the uptake of the COVID-19 vaccine by staff and residents that can inform the implementation of future vaccination programmes.

Racial and Ethnic Disparities in Multisystem Inflammatory Syndrome in Children in the United States, March 2020 to February 2021.

BACKGROUND: The incidence of multisystem inflammatory syndrome in children (MIS-C) varies by race and ethnicity. This study assessed whether disparities in MIS-C in the United States by race and ethnicity exceed known disparities in coronavirus disease 2019 (COVID-19) incidence. METHODS: We compared the distribution of race and ethnicity among patients with MIS-C (<21 years of age, termed children) with onset March 2020 to February 2021 to that of children with COVID-19 and in the general population. Analysis was restricted to 369 counties with high completeness of race and ethnicity reporting for MIS-C and COVID-19. For each racial and ethnic group, observed numbers of patients with MIS-C were compared with expected numbers (observed/expected ratio) in children with COVID-19 and in the general population within these counties. RESULTS: Compared with children in the general population, MIS-C was more frequent among Hispanic (139% of expected) and non-Hispanic Black children (183%) and less frequent among non-Hispanic White (64%) and non-Hispanic Asian children (48%). Compared with children with COVID-19, MIS-C was more frequent in non-Hispanic Black children (207% of expected) and less frequent in non-Hispanic White children (68%); however, frequency was not different among Hispanic (102%) and non-Hispanic Asian (74%) children. CONCLUSIONS: Disparities in MIS-C by race and ethnicity exist, even after controlling for COVID-19 disparities and geographic variations. The high proportion of MIS-C among Hispanic children and low proportion among non-Hispanic Asian children align with COVID-19 rates, while the high proportion among non-Hispanic Black children and low proportion among non-Hispanic White children are not explainable by COVID-19 rates.

Deaths in Children and Adolescents Associated With COVID-19 and MIS-C in the United States.

OBJECTIVES: To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS: We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS: We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS: SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.

Measles Outbreak in a Child Care Center, Cook County, Illinois, 2015.

BACKGROUND: During January-February 2015, Cook County Department of Public Health led an investigation of a measles outbreak predominantly affecting infants at a child care center who were too young for routine immunization with measles-mumps-rubella (MMR) vaccine. METHODS: Measles cases and contacts were investigated by Illinois public health officials. Cases were isolated for 4 days after rash onset. Exposed healthcare workers and child care center staff were required to provide documentation of receipt of 2 doses of MMR vaccine or laboratory evidence of immunity to return to work. Susceptible contacts were actively monitored for 21 days after exposure and provided postexposure prophylaxis (PEP) if certain criteria were met. RESULTS: Fifteen confirmed measles cases were identified; 12 (80%) occurred in infants who were attendees of a child care center. Clinical misdiagnosis of 1 case allowed for continued transmission within the center. Twelve (86%) of 14 exposed infants at the child care center were diagnosed with measles; no other attendees or staff were infected. Five cases visited outpatient pediatric clinics during their infectious period, exposing 33 infants. Six exposed child care center staff and 3 healthcare workers did not have documentation of immunity available and were excluded from work until this was obtained. No healthcare-associated transmission was identified. Ninety-one contacts were actively monitored and 20 received PEP. CONCLUSIONS: This outbreak underscores the vulnerability of infants to measles, the need for early consideration of measles in susceptible patients presenting with a febrile rash illness, and the importance of immunity among individuals working closely with infants.

Connecting Socially Isolated Older Rural Adults with Older Volunteers through Expressive Arts.

Employing a participatory arts-based research approach, we examined an innovative program from rural Ontario, Canada, designed to address social isolation among older people. Older socially isolated adults were matched to trained volunteers, where in dyads, the eight pairs created expressive art in their home setting over the course of 10 home visits. With thematic and narrative inquiry, we analysed the experiences and perceptions of the program leader, older participants, and older volunteers via their artistic creations, weekly logs, evaluations, and field notes. The findings reveal a successful intervention that positively influenced the well-being of older adult participants and older volunteers, especially in regards to relationships, personal development, and creating meaning as well as extending the intervention's impact beyond the program's duration. We also discuss opportunities for similar programs to inform policy and enable positive community-based health and social service responses to rural social isolation.

Extraosseous osteosarcoma in a maned wolf (Chrysocyon brachyurus).

A 6-yr-old maned wolf (Chrysocyon brachyurus) was diagnosed with an extraosseous osteosarcoma on the lateral aspect of the right thigh. Antemortem radiography revealed a calcified mass with no skeletal involvement. The mass was excised, but visible regrowth of the tumor was evident within 5 wk. Histologic examination and immunohistochemistry, including staining for p53 tumor suppression gene protein, were performed on the excised mass. The maned wolf was euthanized 13 wk after the initial diagnosis. The neoplasm was located in a site commonly used for the delivery of intramuscular injections, including vaccinations. Although no definitive association can be made, it is worth noting this relationship, as vaccine-site neoplasias have been observed in other species, most notably the domestic cat (Felis domesticus).

Visible Voices: Expressive arts with isolated seniors using trained volunteers.

This practice-based paper describes an innovative program from Ontario, Canada that explored the potential for volunteer-facilitated expressive arts to contribute to the well-being of socially isolated rural seniors. Inspired by Arts on Prescription initiatives in the UK and coordinated by a Registered Expressive Arts Consultant/Educator, the program involved eight older volunteers and eight older participants engaged in a 10-week series of one-on-one intermodal art-making activities in the participants' homes and institutional settings in 2009-2010. An evaluation of the program design and implementation is presented and the challenges and opportunities of expressive arts with isolated seniors using trained volunteers are discussed.