MMWR. Morbidity and mortality weekly report最新文献

In the United States, arthropodborne viruses (arboviruses) are primarily transmitted by infected mosquitoes or ticks. Most infections are asymptomatic; symptomatic infections range from mild febrile illness to severe neuroinvasive disease. This report summarizes 2023 data for nationally notifiable domestic arboviral diseases. Forty-eight states and the District of Columbia reported 2,770 human arboviral disease cases, including 2,022 (73%) hospitalizations and 208 (8%) deaths. As in previous years, West Nile virus (WNV) was the most commonly reported domestic arboviral disease in 2023, accounting for 2,628 (95%) of all reported cases. A majority (91%) of case onsets occurred during July-September. Three WNV disease cases among patients infected though organ transplantation from two donors were reported in 2023. Powassan virus disease case reports were the second most common (n = 49), having increased from the previous record high in 2022, with onsets evenly distributed during April-December. La Crosse virus was the most common cause of arboviral disease among children, with most cases classified as neuroinvasive. Variations in annual arboviral disease incidence, distribution, and seasonal temporality highlight the importance of high-quality and timely surveillance. Clinicians should consider arboviral testing in patients with acute febrile or neurologic illness when mosquitoes and ticks are active and report positive test results to their health department. Reducing arboviral disease morbidity and mortality relies on population use of personal protective measures (e.g., insect repellent and protective clothing), implementing vector control efforts, and screening blood and organ donors for WNV.

Firearms are the most common means of suicide in the United States and a leading cause of death among all persons aged 10-64 years. Most persons who die by suicide see a clinician in the year preceding their death; thus, health care encounters are important opportunities for suicide prevention. Persons who die by firearm suicide differ demographically and clinically from those who die by other suicide means, suggesting that opportunities for prevention might also differ between these groups. This report examined patterns of health care use in the year preceding suicide death to identify potential opportunities for prevention among persons who died by firearm suicide and those who died by other means of suicide. State cause-of-death records for 2020-2022 were linked to electronic health records from health systems in Alaska (Southcentral Foundation) and Colorado and Washington (both Kaiser Permanente). Quarterly past-year health care use preceding death was examined across service settings, including primary care, outpatient mental health specialty care, emergency care, and inpatient care. During 2020-2022, across the three health systems, 683 persons died by suicide. The majority of these deaths (54.6%) occurred by firearm. Patterns of past-year health care use preceding suicide were similar for persons who died by firearm and other suicide means, with the exception of mental health care, which was significantly lower in specialty and primary care settings. These findings suggest that many persons who die by firearm suicide do not access mental health care before their death. Suicide prevention practices in health care, designed to help identify and engage persons at risk in supportive care, need to reach beyond mental health encounters, particularly for firearm suicide prevention.

Obesity affects approximately one in five U.S. adolescents. Although an increasing number of medications are approved for adolescent obesity as an adjunct to health behavior and lifestyle treatment, national data on the prevalence and correlates of obesity medication prescribing for adolescents are sparse. Ambulatory electronic medical record data were analyzed to assess trends in the proportion of U.S. adolescents aged 12-17 years with obesity (body mass index ≥95th percentile) who were prescribed Food and Drug Administration (FDA) -approved obesity medications during 2018-2023. Log-binomial models were used to estimate characteristics of adolescents associated with receiving an obesity medication prescription in 2023. The proportion of U.S. adolescents who were prescribed obesity medications increased substantially in 2023 (by approximately 300% compared with 2020), the year after FDA expanded its approval of two obesity medications to include adolescents and after publication of the 2023 American Academy of Pediatrics clinical practice guideline. Despite this substantial relative increase, 0.5% of adolescents with obesity were prescribed an obesity medication in 2023, with a majority (83%) of prescriptions received by adolescents with severe obesity. Semaglutide (Wegovy, indicated for persons aged ≥12 years with obesity), and phentermine or phentermine-topiramate were most commonly prescribed. Prescribing prevalence was higher among girls than among boys (adjusted prevalence ratio [aPR] = 2.05), among adolescents aged 15-17 years than among those aged 12-14 years (aPR = 2.24), and among those with severe (class 2 or class 3) obesity than among those with class 1 obesity (aPR = 4.03 and 12.78, respectively). Prescribing prevalence was lower among Black or African American adolescents than among White adolescents (aPR = 0.61). Continued monitoring of the use of these medications could help guide strategies to ensure that all adolescents with obesity have access to evidence-based obesity treatment, including medications and health behavior and lifestyle interventions.

In 2022, Nevada ranked eighth in the United States in incidence of congenital syphilis, a disease that can lead to stillbirth, miscarriage, or neonatal death. Appropriate and timely screening of pregnant females for syphilis and treatment, when indicated, are crucial for preventing congenital syphilis. Southern Nevada Health District (Clark County) disease surveillance data for 2017-2022 were reviewed to identify females of reproductive age (aged 15-44 years) with confirmed or probable syphilis who had a liveborn or stillborn infant with congenital syphilis and to assess their receipt of prenatal care, syphilis testing and, when indicated, syphilis treatment. Clark County emergency department (ED) visit data were reviewed for these females to explore whether ED visits might represent an opportunity to screen pregnant females for syphilis. Among 195 females identified, 43.1% (84) reported receiving prenatal care during pregnancy. Over one half (57.4%) of the females had at least one ED encounter ≥30 days before delivery and had not yet received testing for syphilis at the time of the encounter; syphilis testing was performed at 68.4% of these encounters. Lack of prenatal care was a considerable barrier to timely testing and treatment in Clark County, Nevada. Encounters in nontraditional care settings, including but not limited to EDs, could provide an opportunity for syphilis screening of pregnant females who do not access prenatal care. If linked to timely treatment, such encounters might help prevent congenital syphilis.

Although data on housing status can guide health promotion and effective public health response, a validated question set to measure housing status is not available. In June 2023, the Fulton County Board of Health (FCBOH) requested CDC technical assistance to field test a housing status question set for public health case interviews and surveillance. The question set can be asked of any relevant period to determine both homelessness status and residence in a congregate setting. Field testing was performed at food pantries and FCBOH tuberculosis, vaccination, and sexual health clinics in Fulton County, Georgia, during August 2-September 1, 2023. Among 481 respondents who were asked about their living situation during the previous 2 weeks, 139 (28.9%) reported experiencing homelessness and 75 (15.6%) reported living in congregate settings. Twenty-six of these 481 respondents were identified in a local housing database (the Homeless Management Information System [HMIS]); for 24 of these 26 respondents (92%), the housing status recorded in HMIS matched that determined by the question set. The question set would benefit from validation in additional settings and could help health agencies improve housing data accuracy and consistency, optimizing measures to assist persons at higher risk.

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus transmitted sporadically from camels to humans. Most reported human Middle East respiratory syndrome (MERS) cases have occurred in or near the Arabian Peninsula. Limited human-to-human transmission can occur after close contact and has resulted in health care-associated outbreaks. Global reported MERS cases, U.S. testing data, and data on incoming U.S. travelers originating in and near the Arabian Peninsula during 2017-2023 were analyzed to guide U.S. MERS preparedness. Global MERS cases reported to the World Health Organization declined during the COVID-19 pandemic and remain substantially lower than during years preceding the pandemic. U.S. MERS-CoV testing numbers also declined and remain low relative to the prepandemic period. Although the number of travelers coming to the United States from in or near the Arabian Peninsula declined during the pandemic, incoming traveler volume returned to prepandemic levels. Further investigations are needed to determine whether the decline in global MERS cases reflects a true decrease in the number of infections, underascertainment of cases, or a combination. U.S. MERS persons under investigation criteria, standard clinical and epidemiologic characteristics used to guide who in the U.S. is tested for MERS-CoV, were updated in 2024 and can be used to guide clinicians and jurisdictional public health partners when considering MERS-CoV testing. Continued and targeted MERS-CoV material surveillance is important to maintaining preparedness and promptly responding to potential MERS cases.

A sudden unexpected infant death (SUID) is defined as the sudden and unexpected death of an infant (a child aged <1 year) whose cause of death was not obvious before investigation. Pillows used to support infants during feeding, often referred to as nursing pillows, have been identified as a potential hazard in sleep spaces for infants. Georgia county-level Child Death Review (CDR) data from the Pediatric National Fatality Review Case Reporting System were analyzed to ascertain whether nursing pillows were found in the sleep space of infants who died of SUID. Among 1,685 SUID cases in Georgia during 2013-2022, a nursing pillow was found in the sleep space of 84 (5%) infants. Among these, 86% of infants who died with a nursing pillow present were aged <4 months, 40% were aged <2 months, and 55% were Black or African American. A total of 56% of the deaths occurred in an adult bed, and all but one (99%) occurred in association with bed sharing. Among the 84 deaths, the nursing pillow was found under the infant in 58 (69.1%) cases, next to the infant in 14 (16.7%) cases, on top of the infant in two (2.4%) cases, and tangled around the infant in one (1.2%) case. This analysis indicates that nursing pillows are being used in ways other than their intended use as an aid in feeding. Since April 2025, newly manufactured nursing pillows must have labels indicating the potential risk associated with using them in infants' sleep spaces; however, many nursing pillows in use or still on the market lack such labeling. Warning consumers of risks associated with using nursing pillows in infant sleep environments, in addition to continued education and outreach about safe infant sleep, could help reduce SUIDs.

Economic hardship can limit the ability of workers to prevent and address adverse health conditions. Using 2022 and 2023 Behavioral Risk Factor Surveillance System data, this exploratory analysis assessed economic hardship measures and self-rated health among currently employed and recently unemployed (<12 months) U.S. adults. Measures of economic hardship were 1) employment instability, 2) food insecurity, 3) housing insecurity, 4) utility insecurity, 5) lack of reliable transportation, 6) receipt of food stamps or Supplemental Nutrition Assistance Program benefits, 7) lack sof health insurance, and 8) cost as a barrier to needed medical care. Overall, 6.9% of currently or recently employed U.S. adults in 36 states and the U.S. Virgin Islands had high levels of economic hardship (reporting at least four of eight economic hardship indicators), and 12.5% reported having fair or poor health. High levels of economic hardship were more common among persons who were recently unemployed, were aged 18-49 years, were female, were Hispanic or Latino (Hispanic) or non-Hispanic Black or African American, had a high school education or less, or had a household income <$50,000 per year than among all workers combined. Fair or poor self-rated health was most common among workers who were Hispanic or were from lower educational attainment and income categories. By occupational group, the prevalence of high levels of economic hardship was highest in farming, fishing, and forestry (18.5%); building and grounds cleaning and maintenance (18.2%); and food preparation and serving (16.0%) and was lowest in the legal occupations (1.2%). Among occupational groups, the prevalence of fair or poor health generally increased with the prevalence of high economic hardship, and almost every occupational group with a high level of economic hardship had a statistically significantly elevated prevalence of fair or poor health compared with that among all workers combined. Given associations between unmet economic needs and health, these findings can be used by policymakers to identify groups of workers with disproportionate economic hardships and develop strategies to enhance economic security and health for all workers.