MMWR. Morbidity and mortality weekly report最新文献

Oral pre-exposure prophylaxis (PrEP) reduces HIV acquisition risk from sex by 99% and from injection drug use by ≥74% when used as recommended. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a goal of 21.2 million persons using (initiating or continuing) PrEP globally in 2025. In 2016, CDC, with the U.S. President's Emergency Plan for AIDS Relief, joined ministries of health to implement PrEP globally. PrEP is beneficial for persons at substantial risk for acquiring HIV, including but not limited to key populations, which include female sex workers, men who have sex with men, persons in prisons and other enclosed settings, persons who inject drugs, and transgender persons. Annual country targets were used to guide scale-up. In 2023, CDC supported 856,816 PrEP initiations, which represents nearly one quarter of the 3.5 million persons globally who either initiated or continued PrEP that year. During 2017-2023, CDC supported PrEP initiations for 2,278,743 persons, 96.0% of whom were in sub-Saharan Africa. More than one half (64.0%) were female and 44.9% were aged 15-24 years. Overall, CDC achieved 118.7% of its PrEP initiation targets for the 7-year period. Among PrEP initiations for key populations, the majority in sub-Saharan Africa were female sex workers, whereas in Southeast Asia, Eurasia, and the Americas, the majority were men who have sex with men. Continued rapid scale-up is needed to meet the UNAIDS goal to end HIV as a public health threat.

In most persons, human parvovirus B19 (B19) causes a mild respiratory illness, but infection can result in adverse health outcomes in persons who are pregnant, immunocompromised, or who have chronic hemolytic blood disorders. During the first quarter of 2024, several European countries reported increases in B19 activity. In the United States, there is no routine surveillance for B19. To assess increases in B19 activity in the United States, trends in testing and results from two independent populations were examined: 1) the presence of immunoglobulin (Ig) M antibodies, a marker of recent infection, in clinical specimens ordered by physicians and 2) B19 nucleic acid amplification testing (NAAT) in pooled donor source plasma from a large commercial laboratory during 2018-2024. The proportion of IgM-positive clinical specimens reached 9.9% in the second quarter (Q2) of 2024 after remaining <1.5% during 2020-2023 and was higher than Q2 peaks in 2018 (3.8%, p<0.001) and 2019 (5.1%, p<0.001). The prevalence of B19-NAAT-positive donor pools (512 donations per pool) reached 20% in June 2024 after remaining <2% during 2020-2023 and was higher than peaks in 2018 (6.7%, p<0.001) and 2019 (7.3%, p<0.001). Considering the B19 activity increase in the United States in 2024, promotion of measures to prevent respiratory viruses and monitor for adverse B19-related outcomes by health care providers and public health authorities might reduce adverse health outcomes in pregnant persons and others at increased risk.

Rocky Mountain spotted fever (RMSF) is a tickborne disease endemic in areas of the Americas. Persistent high incidence of the disease exists in northern Mexico, perpetuated by local populations of brown dog ticks (Rhipicephalus sanguineus sensu lato) and free-roaming dogs. Six cases of RMSF caused by Rickettsia rickettsii, including three deaths, were reported to the California Department of Public Health during July 2023-January 2024. All six patients were eventually determined to have had exposure to R. rickettsii in Tecate, Mexico, a municipality on the U.S. border that had not been previously described as a high-risk RMSF area. Identification and reporting of the cases were complicated by challenges in diagnosis. The serious nature of the disease and delays in initiating appropriate treatment can result in life-threatening consequences. Epidemiologic collaborations among local, state, federal, and international public health agencies were essential to identifying Tecate as the location of exposure. Further collaborations will be important for directing future prevention measures. Increased health care provider awareness of RMSF is critical on both sides of the border to facilitate earlier diagnosis and initiation of appropriate treatment.

Nursing home residents are at elevated risk for severe complications from respiratory viruses, including SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Nursing homes are required to report COVID-19 vaccination coverage and can voluntarily report influenza and RSV vaccination coverage among residents to CDC's National Healthcare Safety Network. The purpose of this study was to assess COVID-19, influenza, and RSV vaccination coverage among nursing home residents early in the 2024-25 respiratory virus season. As of November 10, 2024, 29.7% of nursing home residents had received a 2024-2025 COVID-19 vaccine. Among residents at facilities that elected to report vaccination against influenza (59.4% of facilities) and RSV (51.8% of facilities), 58.4% had received influenza vaccination, and 17.9% had received RSV vaccination. Vaccination coverage varied by U.S. Department of Health and Human Services region, social vulnerability index level, and facility size. Addressing low coverage with COVID-19, influenza, and RSV vaccines is a priority to protect residents who are susceptible to severe outcomes associated with respiratory illnesses.

The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza and COVID-19 vaccination for all persons aged ≥6 months, including adults aged ≥18 years. ACIP also recommends a single lifetime dose of respiratory syncytial virus (RSV) vaccine for adults aged ≥75 years and for those aged 60-74 years who are at increased risk for severe RSV disease. Data from the National Immunization Survey-Adult COVID Module, a random-digit-dialed cellular telephone survey of U.S. adults aged ≥18 years, are used to monitor influenza, COVID-19, and RSV vaccination coverage. By the week ending November 9, 2024, an estimated 34.7% of adults aged ≥18 years reported having received an influenza vaccine, and 17.9% reported having received a COVID-19 vaccine for the 2024-25 respiratory virus season; 39.7% of adults aged ≥75 years, and 31.6% of adults aged 60-74 years at increased risk for severe RSV, had ever received an RSV vaccine. Coverage varied by jurisdiction and demographic characteristics and was lowest among younger adults and those without health insurance. Although early season estimates indicate that many adults are unprotected from respiratory virus infections, many appeared open to vaccination: overall, approximately 35% and 41% of adults aged ≥18 years reported that they definitely or probably will receive or were unsure about receiving influenza and COVID-19 vaccines, respectively, and 40% of adults aged ≥75 years reported that they definitely or probably will receive or were unsure about receiving RSV vaccine. Health care providers and immunization programs still have time to expand outreach activities and promote vaccination to increase coverage in preparation for the height of the respiratory virus season. Using these data can help health care providers and immunization programs identify undervaccinated populations and understand vaccination patterns to guide planning, implementation, and evaluation of vaccination activities.

Public health practitioners rely on timely surveillance data for planning and decision-making; however, surveillance data are often subject to delays. Epidemic trend categories, based on time-varying effective reproductive number (R_t) estimates that use nowcasting methods, can mitigate reporting lags in surveillance data and detect changes in community transmission before reporting is completed. CDC analyzed the performance of epidemic trend categories for COVID-19 during summer 2024 in the United States and at the state level in New Mexico. COVID-19 epidemic trend categories were estimated and released in real time based on preliminary data, then retrospectively compared with final emergency department (ED) visit data to determine their ability to detect or confirm real-time changes in subsequent ED visits. Across the United States and in New Mexico, epidemic trend categories were an early indicator of increases in COVID-19 community transmission, signifying increases in COVID-19 community transmission in May, and a confirmatory indicator that decreasing COVID-19 ED visits reflected actual decreases in COVID-19 community transmission in September, rather than incomplete reporting. Public health decision-makers can use epidemic trend categories, in combination with other surveillance indicators, to understand whether COVID-19 community transmission and subsequent ED visits are increasing, decreasing, or not changing; this information can guide communications decisions.