MMWR. Morbidity and mortality weekly report最新文献

Before October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended use of a pneumococcal conjugate vaccine (PCV) for all adults aged ≥65 years, as well as for those aged 19-64 years with risk conditions for pneumococcal disease who have not received a PCV or whose vaccination history is unknown. Options included either 20-valent PCV (PCV20; Prevnar20; Wyeth Pharmaceuticals) or 21-valent PCV (PCV21; CAPVAXIVE; Merck Sharp & Dohme) alone or 15-valent PCV (PCV15; VAXNEUVANCE; Merck Sharp & Dohme) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23; Merck Sharp & Dohme). There are additional recommendations for use of PCV20 or PCV21 for adults who started their pneumococcal vaccination series with 13-valent PCV (PCV13; Prevnar13; Wyeth Pharmaceuticals). The ACIP Pneumococcal Vaccines Work Group employed the Evidence to Recommendations framework to guide its deliberations on expanding the age-based PCV recommendation to include adults aged 50-64 years. On October 23, 2024, ACIP recommended a single dose of PCV for all PCV-naïve adults aged ≥50 years. Recommendations for PCVs among adults aged 19-49 years with risk conditions and PCV13-vaccinated adults have not changed from previous recommendations. This report summarizes evidence considered for these recommendations and provides updated clinical guidance for use of PCV.

Workers in electronics waste and lamp recycling facilities are at risk of exposure to elemental mercury through inhalation of mercury vapor and mercury-containing dust. Employers at an electronics waste and lamp recycling facility in Ohio that crushes mercury-containing lamps expressed concerns about mercury exposure from work processes and requested a health hazard evaluation by CDC's National Institute for Occupational Safety and Health (NIOSH). In April 2023, NIOSH conducted a multidisciplinary investigation to assess elemental and inorganic mercury exposures, including epidemiologic, environmental, and ventilation assessments. Results indicated that mercury vapor was detected throughout the facility, with six of 14 workers having elevated urine mercury levels. These workers had a median job tenure of 8 months; four did not speak English, and five reported symptoms consistent with mercury toxicity, such as metallic or bitter taste, difficulty thinking, and changes in personality. Recommendations included improving the ventilation system, changing work practices to reduce mercury exposure, and providing training and communication tailored to the worker. As the electronic waste recycling industry continues to grow, it is important for employers to evaluate mercury exposure and safeguard employees using a hierarchy of controls. Health departments should consider monitoring occupational mercury exposure in recycling facilities, and clinicians should be aware of the potential for mercury toxicity among workers in these settings.

Tularemia is a rare nationally notifiable zoonosis, caused by the tier-1 select agent Francisella tularensis, that has been reported from all U.S. states except Hawaii. Clinical manifestations typically include fever and localized symptoms that vary by route of infection. The case fatality rate of tularemia is typically <2% but can be higher depending on clinical manifestation and infecting strain. Tularemia is treatable with antibiotics. During 2011-2022, a total of 47 states reported 2,462 tularemia cases, but four central states (Arkansas, Kansas, Missouri, and Oklahoma) accounted for 50% of all reported cases. Incidence was highest among children aged 5-9 years (0.083 per 100,000 population) and adult males aged 65-84 years (range = 0.133-0.161). Incidence among American Indian or Alaska Native persons (0.260) was approximately five times that among White persons (0.057). The average annual incidence of tularemia in the United States during 2011-2022 (0.064) was 56% higher than that reported during 2001-2010 (0.041), largely resulting from increased reporting of probable cases. These findings might reflect an actual increase in human infection or improved case detection amid changes in commercially available laboratory tests during this period. Reducing tularemia incidence will require tailored prevention education; mitigating morbidity and mortality will require health care provider education, particularly among providers serving tribal populations, regarding early and accurate diagnosis and treatment.

Human adenoviruses (HAdVs) are typically associated with mild respiratory illnesses, although severe disease and outbreaks in congregate settings occur. The National Adenovirus Type Reporting System (NATRS) is a passive, laboratory-based surveillance system that monitors trends in circulation of HAdV types in the United States. This report summarizes the distribution of HAdV types reported to NATRS during 2017-2023. During this 7-year period, 2,241 HAdV specimens with typing results were reported to NATRS. The number of specimens with HAdV typing results reported varied annually during 2017-2019 (range = 389-562) and declined during 2020-2023 (range = 58-356). During 2017-2023, six HAdV types (1-4, 7, and 14) accounted for 88.3% of typed specimens reported; 17.0% of specimens were identified as outbreak-related. An increase in type 41 reporting was associated with a hepatitis cluster during 2021-2022. Reporting to NATRS has declined since the COVID-19 pandemic, despite continued HAdV circulation reported through passive laboratory surveillance to the National Respiratory and Enteric Virus Surveillance System. Enhanced participation in NATRS is needed to improve monitoring of circulating HAdV types.

Since the Global Polio Eradication Initiative began in 1988, wild poliovirus (WPV) types 2 and 3 have been eradicated, and annual polio case numbers have decreased by >99.9%. WPV type 1 (WPV1) transmission remains endemic in Afghanistan and Pakistan, two countries that share a 1,600-mile (2,600-km) border. This report describes immunization and surveillance activities and progress toward polio eradication in Afghanistan during January 2023-September 2024. As of November 1, Afghanistan reported 23 WPV1 cases in 2024, with onset during January-September 30, 2024. During the 3 previous years, 12 WPV1 cases were reported, including six during 2023. In August 2021, the Taliban took control nationwide and allowed increased geographic access for poliovirus vaccination campaigns. Multiple challenges have affected polio eradication activities in Afghanistan, including mandated repatriation of approximately 1 million Afghans by Pakistan beginning in late 2023, the ongoing humanitarian crisis that limits international agency effectiveness, polio program constraints imposed by authorities, and increased restrictions on female participation in vaccination activities. House-to-house vaccination coverage reached 90%-98% of children during June-July 2024. Beginning in 2021, authorities had progressively lifted restrictions on house-to-house campaigns, but abruptly reverted to national restrictions in September 2024. Both nationwide house-to-house activities and strengthening of the routine childhood immunization program would help ensure that every vulnerable child is vaccinated and provide a pathway to polio eradication in Afghanistan.