MMWR. Morbidity and mortality weekly report最新文献

Foodborne botulism is a rare and potentially fatal illness caused by ingestion of food containing botulinum neurotoxin produced by the bacterium Clostridium botulinum or other neurotoxigenic Clostridium species. C. botulinum can grow in improperly prepared or stored food items such as home-canned or home-preserved vegetables. On June 25, 2024, the Fresno County Department of Public Health and California Department of Public Health, in collaboration with CDC and two local hospitals, initiated an investigation of a foodborne botulism outbreak linked to two related family gatherings in Fresno County, California. A total of 31 persons attended one or both gatherings. Eight attendees had symptoms compatible with botulism and received botulism antitoxin; five of eight had botulinum neurotoxin type A (BoNT/A) detected in serum. Patients had hospital stays ranging from 2 to 42 days, six patients were admitted to an intensive care unit, and two required invasive mechanical ventilation; all survived. Epidemiologic investigation identified home-preserved prickly pear cactus pads (nopales) included in a homemade salad and served at both events as a food item of interest; laboratory testing confirmed the nopales salad as the source of BoNT/A. This foodborne botulism outbreak is the first reported to be linked to home canning of nopales, a popular vegetable used in traditional Mexican cuisine. Rapid public health coordination is essential for responses to foodborne botulism outbreaks. Enhancing community and clinician awareness of foodborne botulism by increasing access to culturally and linguistically accessible home food preservation and canning guidelines might help prevent future outbreaks.

Mycoplasma pneumoniae is a common bacterial cause of respiratory infection and a leading cause of childhood community-acquired pneumonia (CAP). Increases in M. pneumoniae infection occur every 3-5 years. In the United States, M. pneumoniae prevalence decreased during and immediately after the COVID-19 pandemic. Information from 42 U.S. children's hospitals that provided information to the Pediatric Health Information System, a database of clinical and resource use information, was used to identify discharge diagnostic codes for 2018-2024 indicating M. pneumoniae infection. M. pneumoniae-associated CAP incidence among children aged ≤18 years was significantly higher in 2024 (12.5 per 1,000 hospitalizations) than during 2018-2023 (2.1). During the study period, an M. pneumoniae diagnostic code was listed in 11.5% of pediatric CAP hospitalizations, peaking at 53.8% in July 2024. Among pediatric M. pneumoniae CAP cases, the highest percentage occurred among children aged 6-12 years (42.6%), followed by children aged 2-5 years (25.7%) and 13-18 years (21.1%). The lowest occurred among those aged 12-23 months (6.4%) and 0-11 months (4.2%). M. pneumoniae infections in 2024 were not more severe than 2018-2023 infections, as assessed by length of hospitalization and percentage of patients admitted to an intensive care unit. The increase in M. pneumoniae infections in the United States in 2024 might be higher than previous periodic increases because the susceptible population was larger after sustained low incidence during and immediately after the COVID-19 pandemic. Health care providers should be aware of the periodicity of M. pneumoniae CAP and consider testing for this pathogen as a cause of respiratory illness among children of all ages.

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.