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Heat-Related Emergency Department Visits — United States, May–September 2023 美国 2023 年 5 月至 9 月与高温有关的急诊就诊人数
Pub Date : 2024-04-18 DOI: 10.15585/mmwr.mm7315a1
A. Vaidyanathan, Abigail Gates, Claudia Brown, Emily Prezzato, Aaron Bernstein
Unprecedented heat waves can affect all persons, but some are more sensitive to the effects of heat, including children and adults with underlying health conditions, pregnant women, and outdoor workers. Many regions of the United States experienced record-breaking high temperatures in 2023, with populations exposed to extremely high temperatures for prolonged periods. CDC examined emergency department (ED) visits associated with heat-related illness (HRI) from the National Syndromic Surveillance Program and compared daily HRI ED visit rates during the warm-season months (May-September) of 2023 with those during 2018-2022. In the 2023 warm-season months, daily HRI ED visit rates peaked in several regions and remained elevated for a prolonged duration. More males than females sought care in EDs for HRI, especially males aged 18-64 years. CDC issued multiple public health alerts using the Epidemic Information Exchange system to bring attention to increases in ED utilization for HRI. Deaths and illnesses associated with heat exposure are a continuing public health concern as climate change results in longer, hotter, and more frequent episodes of extreme heat. Near real-time monitoring of weather conditions and adverse health outcomes can guide public health practitioners' timing of risk communication and implementation of prevention measures associated with extreme heat.
史无前例的热浪会影响所有人,但有些人对高温的影响更为敏感,包括有潜在健康问题的儿童和成人、孕妇和户外工作者。2023 年,美国许多地区经历了破纪录的高温,人们长时间暴露在极高的温度下。美国疾病预防控制中心研究了国家综合症监测计划(National Syndromic Surveillance Program)中与热相关疾病(HRI)有关的急诊室(ED)就诊情况,并将 2023 年暖季月(5 月至 9 月)与 2018-2022 年暖季月期间的每日 HRI 急诊室就诊率进行了比较。在 2023 年暖季的几个月中,几个地区的每日 HRI 急诊就诊率达到峰值,并在很长一段时间内保持高位。在急诊室就诊的 HRI 患者中,男性多于女性,尤其是 18-64 岁的男性。疾病预防控制中心利用流行病信息交换系统发布了多个公共卫生警报,以引起人们对急诊室因高温中暑而就诊人数增加的关注。随着气候变化导致极端高温的时间更长、温度更高、次数更多,与高温暴露相关的死亡和疾病成为一个持续的公共卫生问题。对天气条件和不良健康后果的近实时监测可以指导公共卫生从业人员适时进行风险交流并实施与酷热相关的预防措施。
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引用次数: 0
COVID-19 Vaccination Coverage, and Rates of SARS-CoV-2 Infection and COVID-19–Associated Hospitalization Among Residents in Nursing Homes — National Healthcare Safety Network, United States, October 2023–February 2024 2023 年 10 月至 2024 年 2 月,美国国家医疗保健安全网络:COVID-19 疫苗接种覆盖率、疗养院居民 SARS-CoV-2 感染率和 COVID-19 相关住院率
Pub Date : 2024-04-18 DOI: 10.15585/mmwr.mm7315a3
David Franklin, Kira Barbre, Theresa Rowe, Hannah Reses, Jason Massey, Lu Meng, Philip Dollard, Heather Dubendris, Molly Stillions, Lindsay Robinson, Jacques W Clerville, K. J. Slifka, Andrea Benin, Jeneita Bell
Nursing home residents are at increased risk for developing severe COVID-19. Nursing homes report weekly facility-level data on SARS-CoV-2 infections, COVID-19-associated hospitalizations, and COVID-19 vaccination coverage among residents to CDC's National Healthcare Safety Network. This analysis describes rates of incident SARS-CoV-2 infection, rates of incident COVID-19-associated hospitalization, and COVID-19 vaccination coverage during October 16, 2023-February 11, 2024. Weekly rates of SARS-CoV-2 infection ranged from 61.4 to 133.8 per 10,000 nursing home residents. The weekly percentage of facilities reporting one or more incident SARS-CoV-2 infections ranged from 14.9% to 26.1%. Weekly rates of COVID-19-associated hospitalization ranged from 3.8 to 7.1 per 10,000 residents, and the weekly percentage of facilities reporting one or more COVID-19-associated hospitalizations ranged from 2.6% to 4.7%. By February 11, 2024, 40.5% of nursing home residents had received a dose of the updated 2023-2024 COVID-19 vaccine that was first recommended in September 2023. Although the peak rate of SARS-CoV-2 infection among nursing home residents was lower during the 2023-24 respiratory virus season than during the three previous respiratory virus seasons, nursing home residents continued to be disproportionately affected by SARS-CoV-2 infection and related severe outcomes. Vaccination coverage remains suboptimal in this population. Ongoing surveillance for SARS-CoV-2 infections and COVID-19-associated hospitalizations in this population is necessary to develop and evaluate evidence-based interventions for protecting nursing home residents.
疗养院居民罹患严重 COVID-19 的风险增加。疗养院每周都会向疾病预防控制中心的国家医疗保健安全网络报告有关 SARS-CoV-2 感染、COVID-19 相关住院以及居民 COVID-19 疫苗接种率的设施级数据。本分析报告描述了 2023 年 10 月 16 日至 2024 年 2 月 11 日期间 SARS-CoV-2 感染率、COVID-19 相关住院率和 COVID-19 疫苗接种率。每 10,000 名养老院居民中,每周 SARS-CoV-2 感染率从 61.4 到 133.8 不等。每周报告一起或多起 SARS-CoV-2 感染事件的机构比例从 14.9% 到 26.1%不等。COVID-19 相关的每周住院率为每 10,000 名住院者中有 3.8 至 7.1 例,每周报告有一例或多例 COVID-19 相关住院病例的机构比例为 2.6% 至 4.7%。截至 2024 年 2 月 11 日,40.5% 的养老院居民接种了 2023 年 9 月首次推荐的 2023-2024 年更新版 COVID-19 疫苗。尽管在 2023-24 年呼吸道病毒流行季节,养老院居民感染 SARS-CoV-2 的峰值率低于前三个呼吸道病毒流行季节,但养老院居民受 SARS-CoV-2 感染和相关严重后果的影响仍然不成比例。这一人群的疫苗接种覆盖率仍未达到最佳水平。有必要对这一人群中的 SARS-CoV-2 感染和 COVID-19 相关住院病例进行持续监测,以制定和评估保护疗养院居民的循证干预措施。
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引用次数: 1
Use of the Pfizer Pentavalent Meningococcal Vaccine Among Persons Aged ≥10 Years: Recommendations of the Advisory Committee on Immunization Practices ― United States, 2023 辉瑞五价脑膜炎球菌疫苗在年龄≥10 岁人群中的使用:免疫实践咨询委员会的建议 - 美国,2023 年
Pub Date : 2024-04-18 DOI: 10.15585/mmwr.mm7315a4
Jennifer P Collins, Samuel J Crowe, Ismael R. Ortega-Sanchez, Lynn Bahta, Doug Campos-Outcalt, Jamie Loehr, Rebecca L Morgan, K. Poehling, Lucy A McNamara
Meningococcal disease is a life-threatening invasive infection caused by Neisseria meningitidis. Two quadrivalent (serogroups A, C, W, and Y) meningococcal conjugate vaccines (MenACWY) (MenACWY-CRM [Menveo, GSK] and MenACWY-TT [MenQuadfi, Sanofi Pasteur]) and two serogroup B meningococcal vaccines (MenB) (MenB-4C [Bexsero, GSK] and MenB-FHbp [Trumenba, Pfizer Inc.]), are licensed and available in the United States and have been recommended by CDC's Advisory Committee on Immunization Practices (ACIP). On October 20, 2023, the Food and Drug Administration approved the use of a pentavalent meningococcal vaccine (MenACWY-TT/MenB-FHbp [Penbraya, Pfizer Inc.]) for prevention of invasive disease caused by N. meningitidis serogroups A, B, C, W, and Y among persons aged 10-25 years. On October 25, 2023, ACIP recommended that MenACWY-TT/MenB-FHbp may be used when both MenACWY and MenB are indicated at the same visit for the following groups: 1) healthy persons aged 16-23 years (routine schedule) when shared clinical decision-making favors administration of MenB vaccine, and 2) persons aged ≥10 years who are at increased risk for meningococcal disease (e.g., because of persistent complement deficiencies, complement inhibitor use, or functional or anatomic asplenia). Different manufacturers' serogroup B-containing vaccines are not interchangeable; therefore, when MenACWY-TT/MenB-FHbp is used, subsequent doses of MenB should be from the same manufacturer (Pfizer Inc.). This report summarizes evidence considered for these recommendations and provides clinical guidance for the use of MenACWY-TT/MenB-FHbp.
脑膜炎球菌病是由奈瑟氏脑膜炎球菌引起的一种危及生命的侵袭性感染。两种四价(A、C、W 和 Y 血清群)脑膜炎球菌结合疫苗(MenACWY)(MenACWY-CRM [Menveo, GSK] 和 MenACWY-TT [MenQuadfi, Sanofi Pasteur])和两种 B 血清群脑膜炎球菌疫苗(MenB)(MenB-4C [Bexsero, GSK] 和 MenB-FHbp [Trumenba, Pfizer Inc.)在美国获得了许可并可以使用,而且已被美国疾病预防控制中心免疫实践咨询委员会 (ACIP) 推荐。)2023 年 10 月 20 日,美国食品和药物管理局批准在 10-25 岁人群中使用五价脑膜炎球菌疫苗(MenACWY-TT/MenB-FHbp [Penbraya, Pfizer Inc.])预防由脑膜炎双球菌血清 A、B、C、W 和 Y 群引起的侵袭性疾病。2023 年 10 月 25 日,ACIP 建议,当 MenACWY 和 MenB 均适用于以下人群时,可在同一次就诊时接种 MenACWY-TT/MenB-FHbp:1)16-23 岁的健康人群(常规接种计划),当临床共同决策倾向于接种 MenB 疫苗时;2)年龄≥10 岁、脑膜炎球菌疾病风险增加的人群(例如,由于持续补体缺乏、使用补体抑制剂或功能性或解剖性无胰腺)。不同生产商生产的含血清 B 群的疫苗不能互换;因此,在使用 MenACWY-TT/MenB-FHbp 疫苗时,后续剂量的 MenB 疫苗应来自同一生产商(辉瑞公司)。本报告总结了这些建议所考虑的证据,并为 MenACWY-TT/MenB-FHbp 的使用提供了临床指导。
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引用次数: 1
Durability of Original Monovalent mRNA Vaccine Effectiveness Against COVID-19 Omicron–Associated Hospitalization in Children and Adolescents — United States, 2021–2023 2021-2023 年美国原始单价 mRNA 疫苗在预防 COVID-19 Omicron 相关儿童和青少年住院治疗方面的效力持续时间
Pub Date : 2024-04-18 DOI: 10.15585/mmwr.mm7315a2
Laura D. Zambrano, Margaret M. Newhams, Regina M Simeone, Amanda B. Payne, Michael Wu, Amber O Orzel-Lockwood, N. Halasa, Jemima M Calixte, Pia S Pannaraj, K. Mongkolrattanothai, J. Boom, Leila C. Sahni, S. Kamidani, K. Chiotos, M. Cameron, A. Maddux, K. Irby, J. Schuster, E. Mack, Austin Biggs, B. Coates, Kelly N. Michelson, Katherine E Bline, Ryan A Nofziger, Hillary R Crandall, Charlotte V Hobbs, S. Gertz, Sabrina M. Heidemann, T. Bradford, Tracie C Walker, S. Schwartz, M. Staat, Samina S Bhumbra, J. Hume, Michele Kong, M. Stockwell, Thomas J Connors, M. Cullimore, H. Flori, Emily R Levy, N. Cvijanovich, M. Zinter, Mia Maamari, Cindy Bowens, Danielle M. Zerr, J. Guzman-Cottrill, Ivan Gonzalez, Angela P Campbell, Adrienne G Randolph, M. Murdock, Heather Kelley, Candice Colston, Ronald C. Sanders, Laura Miron, M. Yates, Ashlyn Madding, Alexa Dixon, Michael Henne, Kathleen Sun, Jazmin Baez Maidana, Natalie Triester, Jaycee Jumarang, Daniel Hakimi, Kennis-Grace Mrotek, Liria Muriscot Niell, Natasha Baig, E
Pediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S. children and adolescents aged 5-18 years, using a case-control design. Too few children and adolescents received bivalent or updated monovalent vaccines to separately evaluate their effectiveness. Most case-patients (persons with a positive SARS-CoV-2 test result) were unvaccinated, despite the high frequency of reported underlying conditions associated with severe COVID-19. VE of the original monovalent vaccine against COVID-19-related hospitalizations was 52% (95% CI = 33%-66%) when the most recent dose was administered <120 days before hospitalization and 19% (95% CI = 2%-32%) if the interval was 120-364 days. VE of the original monovalent vaccine against COVID-19-related hospitalization was 31% (95% CI = 18%-43%) if the last dose was received any time within the previous year. VE against critical COVID-19-related illness, defined as receipt of noninvasive or invasive mechanical ventilation, vasoactive infusions, extracorporeal membrane oxygenation, and illness resulting in death, was 57% (95% CI = 21%-76%) when the most recent dose was received <120 days before hospitalization, 25% (95% CI = -9% to 49%) if it was received 120-364 days before hospitalization, and 38% (95% CI = 15%-55%) if the last dose was received any time within the previous year. VE was similar after excluding children and adolescents with documented immunocompromising conditions. Because of the low frequency of children who received updated COVID-19 vaccines and waning effectiveness of original monovalent doses, these data support CDC recommendations that all children and adolescents receive updated COVID-19 vaccines to protect against severe COVID-19.
接种小儿 COVID-19 疫苗可有效预防与 COVID-19 相关的住院治疗,但在 SARS-CoV-2 Omicron 占主导地位期间,原始单价疫苗的保护持续时间值得评估,特别是考虑到更新的 COVID-19 疫苗覆盖率较低。2021 年 12 月 19 日至 2023 年 10 月 29 日期间,克服 COVID-19 网络采用病例对照设计,评估了≥2 剂原始单价 COVID-19 mRNA 疫苗对美国 5-18 岁儿童和青少年中 COVID-19 相关住院和危重病的疫苗有效性 (VE)。接种二价疫苗或更新单价疫苗的儿童和青少年人数太少,无法单独评估其效果。大多数病例患者(SARS-CoV-2 检测结果呈阳性者)都没有接种疫苗,尽管据报道与严重 COVID-19 相关的潜在疾病发生率很高。如果最近一剂疫苗在住院前<120天接种,则原始单价疫苗预防COVID-19相关住院的VE为52%(95% CI = 33%-66%);如果间隔时间为120-364天,则VE为19%(95% CI = 2%-32%)。如果最后一剂疫苗是在前一年的任何时间接种的,那么原始单价疫苗预防COVID-19相关住院的VE为31%(95% CI = 18%-43%)。如果最近一剂疫苗是在住院前<120天接种的,则针对COVID-19相关重症(定义为接受无创或有创机械通气、血管活性输液、体外膜肺氧合以及导致死亡的疾病)的VE为57%(95% CI = 21%-76%);如果最近一剂疫苗是在住院前120-364天接种的,则VE为25%(95% CI = -9%-49%);如果最近一剂疫苗是在前一年的任何时间接种的,则VE为38%(95% CI = 15%-55% )。在排除有免疫力低下记录的儿童和青少年后,VE 相似。由于儿童接种更新的 COVID-19 疫苗的频率较低,而且原始单价剂量的效力正在减弱,因此这些数据支持疾病预防控制中心的建议,即所有儿童和青少年都接种更新的 COVID-19 疫苗,以预防严重的 COVID-19。
{"title":"Durability of Original Monovalent mRNA Vaccine Effectiveness Against COVID-19 Omicron–Associated Hospitalization in Children and Adolescents — United States, 2021–2023","authors":"Laura D. Zambrano, Margaret M. Newhams, Regina M Simeone, Amanda B. Payne, Michael Wu, Amber O Orzel-Lockwood, N. Halasa, Jemima M Calixte, Pia S Pannaraj, K. Mongkolrattanothai, J. Boom, Leila C. Sahni, S. Kamidani, K. Chiotos, M. Cameron, A. Maddux, K. Irby, J. Schuster, E. Mack, Austin Biggs, B. Coates, Kelly N. Michelson, Katherine E Bline, Ryan A Nofziger, Hillary R Crandall, Charlotte V Hobbs, S. Gertz, Sabrina M. Heidemann, T. Bradford, Tracie C Walker, S. Schwartz, M. Staat, Samina S Bhumbra, J. Hume, Michele Kong, M. Stockwell, Thomas J Connors, M. Cullimore, H. Flori, Emily R Levy, N. Cvijanovich, M. Zinter, Mia Maamari, Cindy Bowens, Danielle M. Zerr, J. Guzman-Cottrill, Ivan Gonzalez, Angela P Campbell, Adrienne G Randolph, M. Murdock, Heather Kelley, Candice Colston, Ronald C. Sanders, Laura Miron, M. Yates, Ashlyn Madding, Alexa Dixon, Michael Henne, Kathleen Sun, Jazmin Baez Maidana, Natalie Triester, Jaycee Jumarang, Daniel Hakimi, Kennis-Grace Mrotek, Liria Muriscot Niell, Natasha Baig, E","doi":"10.15585/mmwr.mm7315a2","DOIUrl":"https://doi.org/10.15585/mmwr.mm7315a2","url":null,"abstract":"Pediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S. children and adolescents aged 5-18 years, using a case-control design. Too few children and adolescents received bivalent or updated monovalent vaccines to separately evaluate their effectiveness. Most case-patients (persons with a positive SARS-CoV-2 test result) were unvaccinated, despite the high frequency of reported underlying conditions associated with severe COVID-19. VE of the original monovalent vaccine against COVID-19-related hospitalizations was 52% (95% CI = 33%-66%) when the most recent dose was administered <120 days before hospitalization and 19% (95% CI = 2%-32%) if the interval was 120-364 days. VE of the original monovalent vaccine against COVID-19-related hospitalization was 31% (95% CI = 18%-43%) if the last dose was received any time within the previous year. VE against critical COVID-19-related illness, defined as receipt of noninvasive or invasive mechanical ventilation, vasoactive infusions, extracorporeal membrane oxygenation, and illness resulting in death, was 57% (95% CI = 21%-76%) when the most recent dose was received <120 days before hospitalization, 25% (95% CI = -9% to 49%) if it was received 120-364 days before hospitalization, and 38% (95% CI = 15%-55%) if the last dose was received any time within the previous year. VE was similar after excluding children and adolescents with documented immunocompromising conditions. Because of the low frequency of children who received updated COVID-19 vaccines and waning effectiveness of original monovalent doses, these data support CDC recommendations that all children and adolescents receive updated COVID-19 vaccines to protect against severe COVID-19.","PeriodicalId":18931,"journal":{"name":"Morbidity and Mortality Weekly Report","volume":" 39","pages":"330 - 338"},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140689006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Measles — United States, January 1, 2020–March 28, 2024 麻疹 - 美国,2020 年 1 月 1 日至 2024 年 3 月 28 日
Pub Date : 2024-04-11 DOI: 10.15585/mmwr.mm7314a1
Adria D Mathis, Kelley Raines, Nina B. Masters, Thomas D. Filardo, Gimin Kim, Stephen N Crooke, Bettina Bankamp, Paul A. Rota, David E Sugerman
Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S. measles elimination status was threatened in 2019 as the result of two prolonged outbreaks among undervaccinated communities in New York and New York City. To assess U.S. measles elimination status after the 2019 outbreaks and to provide context to understand more recent increases in measles cases, CDC analyzed epidemiologic and laboratory surveillance data and the performance of the U.S. measles surveillance system after these outbreaks. During January 1, 2020-March 28, 2024, CDC was notified of 338 confirmed measles cases; 97 (29%) of these cases occurred during the first quarter of 2024, representing a more than seventeenfold increase over the mean number of cases reported during the first quarter of 2020-2023. Among the 338 reported cases, the median patient age was 3 years (range = 0-64 years); 309 (91%) patients were unvaccinated or had unknown vaccination status, and 336 case investigations included information on ≥80% of critical surveillance indicators. During 2020-2023, the longest transmission chain lasted 63 days. As of the end of 2023, because of the absence of sustained measles virus transmission for 12 consecutive months in the presence of a well-performing surveillance system, U.S. measles elimination status was maintained. Risk for widespread U.S. measles transmission remains low because of high population immunity. However, because of the increase in cases during the first quarter of 2024, additional activities are needed to increase U.S. routine measles, mumps, and rubella vaccination coverage, especially among close-knit and undervaccinated communities. These activities include encouraging vaccination before international travel and rapidly investigating suspected measles cases.
麻疹是一种传染性极强的发热出疹性疾病,美国于 2000 年宣布消灭麻疹。然而,麻疹的输入仍在继续,2019 年,由于纽约和纽约市接种疫苗不足的社区爆发了两次持续时间较长的疫情,美国的麻疹消灭状态受到威胁。为了评估美国在 2019 年疫情爆发后的麻疹消除状况,并为了解近期麻疹病例的增加提供背景资料,疾病预防控制中心分析了流行病学和实验室监测数据以及美国麻疹监测系统在这些疫情爆发后的表现。2020 年 1 月 1 日至 2024 年 3 月 28 日期间,疾病预防控制中心共接到 338 例麻疹确诊病例的通知;其中 97 例(29%)发生在 2024 年第一季度,比 2020-2023 年第一季度报告的平均病例数增加了 17 倍多。在报告的 338 例病例中,患者年龄中位数为 3 岁(范围 = 0-64 岁);309 例(91%)患者未接种疫苗或疫苗接种情况不明,336 例病例调查包含了≥80% 的关键监测指标信息。2020-2023 年期间,最长的传播链持续了 63 天。截至 2023 年底,由于监测系统运行良好,连续 12 个月未出现麻疹病毒持续传播,美国麻疹消除状态得以维持。由于人群免疫力高,美国麻疹广泛传播的风险仍然很低。然而,由于 2024 年第一季度病例的增加,需要开展更多活动来提高美国常规麻疹、流行性腮腺炎和风疹疫苗接种覆盖率,尤其是在关系密切和接种疫苗不足的社区。这些活动包括鼓励在国际旅行前接种疫苗,以及迅速调查麻疹疑似病例。
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引用次数: 0
Assessment of Risk for Sudden Cardiac Death Among Adolescents and Young Adults After Receipt of COVID-19 Vaccine — Oregon, June 2021–December 2022 青少年接种 COVID-19 疫苗后心脏性猝死风险评估 - 俄勒冈州,2021 年 6 月至 2022 年 12 月
Pub Date : 2024-04-11 DOI: 10.15585/mmwr.mm7314a5
Juventila Liko, Paul R. Cieslak
COVID-19 vaccination has been associated with myocarditis in adolescents and young adults, and concerns have been raised about possible vaccine-related cardiac fatalities in this age group. In April 2021, cases of myocarditis after COVID-19 vaccination, particularly among young male vaccine recipients, were reported to the Vaccine Adverse Event Reporting System. To assess this possibility, investigators searched death certificates for Oregon residents aged 16-30 years who died during June 2021-December 2022 for cardiac or undetermined causes of death. For identified decedents, records in Oregon's immunization information system were reviewed for documentation of mRNA COVID-19 vaccination received ≤100 days before death. Among 1,292 identified deaths, COVID-19 was cited as the cause for 30. For 101 others, a cardiac cause of death could not be excluded; among these decedents, immunization information system records were available for 88, three of whom had received an mRNA COVID-19 vaccination within 100 days of death. Of 40 deaths that occurred among persons who had received an mRNA COVID-19 vaccine dose, three occurred ≤100 days after vaccination. Two of these deaths were attributed to chronic underlying conditions; the cause was undetermined for one. No death certificate attributed death to vaccination. These data do not support an association between receipt of mRNA COVID-19 vaccine and sudden cardiac death among previously healthy young persons. COVID-19 vaccination is recommended for all persons aged ≥6 months to prevent COVID-19 and complications, including death.
接种 COVID-19 疫苗与青少年和年轻成年人的心肌炎有关,人们担心在这个年龄组中可能会发生与疫苗相关的心脏死亡事件。2021 年 4 月,疫苗不良事件报告系统(Vaccine Adverse Event Reporting System)收到了接种 COVID-19 疫苗后引发心肌炎的病例报告,尤其是在接种疫苗的年轻男性接种者中。为了评估这种可能性,调查人员搜索了俄勒冈州 16-30 岁居民在 2021 年 6 月至 2022 年 12 月期间因心脏病或不明原因死亡的死亡证明。对于已确认的死者,研究人员审查了俄勒冈州免疫信息系统中的记录,以确定其是否在死亡前≤100 天接种过 mRNA COVID-19 疫苗。在已确认的 1292 例死亡病例中,有 30 例的死因是 COVID-19。另外 101 人的死因不能排除心脏原因;在这些死者中,有 88 人的免疫信息系统记录,其中 3 人在死前 100 天内接种过 mRNA COVID-19 疫苗。在接种过 mRNA COVID-19 疫苗的 40 例死亡病例中,有 3 例发生在接种后 100 天以内。其中两例死亡归因于慢性基础疾病;一例死亡原因不明。没有死亡证明将死亡归因于疫苗接种。这些数据不支持以前健康的年轻人接种 mRNA COVID-19 疫苗与心脏性猝死之间存在关联。建议所有年龄≥6个月的人接种COVID-19疫苗,以预防COVID-19和并发症,包括死亡。
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引用次数: 1
COVID-19 Vaccination Coverage — World Health Organization African Region, 2021–2023 COVID-19 疫苗接种覆盖率 - 世界卫生组织非洲地区,2021-2023 年
Pub Date : 2024-04-11 DOI: 10.15585/mmwr.mm7314a3
Reena H Doshi, Sheillah Nsasiirwe, Melissa Dahlke, A. Atagbaza, Oniovo Efe Aluta, Alain Blaise Tatsinkou, Ezekiel Dauda, Alba Vilajeliu, Santosh Gurung, Jayne Tusiime, Fiona Braka, A. Bwaka, Sarah Wanyoike, Donald Brooks, Diana Chang Blanc, James P. Alexander, Benjamin A. Dahl, Ann Lindstrand, C. S. Wiysonge
With the availability of authorized COVID-19 vaccines in early 2021, vaccination became an effective tool to reduce COVID-19-associated morbidity and mortality. Initially, the World Health Organization (WHO) set an ambitious target to vaccinate 70% of the global population by mid-2022. However, in July 2022, WHO recommended that all countries, including those in the African Region, prioritize COVID-19 vaccination of high-risk groups, including older adults and health care workers, to have the greatest impact on morbidity and mortality. As of December 31, 2023, approximately 860 million doses of COVID-19 vaccine had been delivered to countries in the African Region, and 646 million doses had been administered. Cumulatively, 38% of the African Region's population had received ≥1 dose, 32% had completed a primary series, and 21% had received ≥1 booster dose. Cumulative total population coverage with ≥1 dose ranged by country from 0.3% to 89%. Coverage with the primary series among older age groups was 52% (range among countries = 15%-96%); primary series coverage among health care workers was 48% (range = 13%-99%). Although the COVID-19 public health emergency of international concern was declared over in May 2023, current WHO recommendations reinforce the need to vaccinate priority populations at highest risk for severe COVID-19 disease and death and build more sustainable programs by integrating COVID-19 vaccination into primary health care, strengthening immunization across the life course, and improving pandemic preparedness.
随着 COVID-19 授权疫苗于 2021 年初上市,疫苗接种成为降低 COVID-19 相关发病率和死亡率的有效工具。最初,世界卫生组织(WHO)制定了一个雄心勃勃的目标,即到 2022 年中期为全球 70% 的人口接种疫苗。然而,2022 年 7 月,世卫组织建议包括非洲地区国家在内的所有国家优先为包括老年人和医护人员在内的高危人群接种 COVID-19 疫苗,以便对发病率和死亡率产生最大影响。截至 2023 年 12 月 31 日,已向非洲地区国家运送了约 8.6 亿剂 COVID-19 疫苗,并接种了 6.46 亿剂。非洲地区累计有38%的人口接种了≥1剂疫苗,32%的人口完成了初级接种,21%的人口接种了≥1剂加强剂。各国≥1 次接种的累计总人口覆盖率从 0.3% 到 89% 不等。老年群体的初免覆盖率为 52%(各国范围 = 15%-96%);医护人员的初免覆盖率为 48%(各国范围 = 13%-99%)。尽管国际关注的 COVID-19 公共卫生紧急事件已于 2023 年 5 月宣布结束,但世卫组织目前的建议仍强调有必要为 COVID-19 严重疾病和死亡风险最高的重点人群接种疫苗,并通过将 COVID-19 疫苗接种纳入初级卫生保健、加强整个生命过程的免疫接种以及提高大流行病的防备能力来建立更可持续的计划。
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引用次数: 0
Infections Associated with Medtronic Duet External Ventricular Drains — Rhode Island Hospital, Providence, Rhode Island, January 2023–January 2024 与美敦力 Duet 室外引流管有关的感染 - 罗德岛普罗维登斯罗德岛医院,2023 年 1 月至 2024 年 1 月
Pub Date : 2024-04-11 DOI: 10.15585/mmwr.mm7314a4
Kevin M Gibas, Dianne B. Auld, Stephanie Parente, Jean Horoho, Leonard A. Mermel
External ventricular drains (EVDs) are medical devices that are inserted into the ventricles of the brain to drain excess fluid, manage intracranial hypertension, monitor intracranial pressure, and administer medications. Unintentional disconnections and breaks or fractures (breaks) of EVDs or associated drainage system components can result in cerebrospinal fluid (CSF) leakage and increased risk for EVD-associated infections. After replacement of Integra Life Sciences EVD systems with Medtronic Duet EVD systems at Rhode Island Hospital in mid-September 2023, a threefold increase was observed in the prevalence of positive CSF cultures, from 2.8 per 1,000 days with an EVD in place (EVD days) during January-September 2023 to 11.4 per 1,000 EVD days during October 2023-January 2024 (rate ratio [RR] = 5.7; 95% CI = 1.5-22.0; p = 0.01) and an eightfold increase in the prevalence of infections, from 0.7 to 6.5 per 1,000 EVD days (RR = 9.8; 95% CI = 1.1-87.3; p = 0.04). An investigation by Rhode Island Hospital Infection Control during December 2023-January 2024 identified frequent reports of disconnections and breaks of the Medtronic Duet EVD system. A search of the Food and Drug Administration Manufacturer and User Facility Device Experience database identified 326 reports nationwide of disconnection and breaks of components of the Duet EVD system, including 175 during 2023. A Medical Product Safety Network report was filed. The Duet EVD product was ultimately recalled in January 2024, citing disconnections of the EVD system and reports of CSF leakage and infection. Given the widespread use of EVD systems by neurosurgery centers and the risk for EVD-associated infections, a strategy for future consideration by hospital infection prevention and control programs might be inclusion of EVD-associated infections in hospital surveillance programs to rapidly identify increases in these events and determine factors related to such infections to prevent additional infections.
脑室外引流管(EVD)是插入脑室的医疗设备,用于引流多余液体、控制颅内高压、监测颅内压和给药。EVD 或相关引流系统部件的意外断开、断裂或骨折(断裂)会导致脑脊液 (CSF) 泄漏,增加 EVD 相关感染的风险。罗德岛医院在 2023 年 9 月中旬将 Integra Life Sciences EVD 系统更换为 Medtronic Duet EVD 系统后,观察到 CSF 培养阳性率增加了三倍,从 2023 年 1 月至 9 月期间每千个 EVD 就位日(EVD 日)2.8 例增加到 11.4 例。2023 年 10 月至 2024 年 1 月期间,每 1,000 个 EVD 日的 CSF 培养阳性率为 4(比率比 [RR] = 5.7;95% CI = 1.5-22.0;p = 0.01),感染率增加了 8 倍,从每 1,000 个 EVD 日 0.7 例增加到 6.5 例(RR = 9.8;95% CI = 1.1-87.3;p = 0.04)。罗德岛医院感染控制部门在 2023 年 12 月至 2024 年 1 月期间进行的一项调查发现,美敦力 Duet EVD 系统经常出现断开连接和破损的报告。通过搜索食品药品管理局制造商和用户设施设备经验数据库,在全国范围内发现了 326 份关于 Duet EVD 系统组件断开和破损的报告,其中包括 2023 年期间的 175 份报告。已提交医疗产品安全网络报告。Duet EVD 产品最终于 2024 年 1 月被召回,原因是 EVD 系统断开连接以及 CSF 泄漏和感染报告。鉴于神经外科中心广泛使用 EVD 系统以及 EVD 相关感染的风险,医院感染预防和控制计划未来可能考虑的一项策略是将 EVD 相关感染纳入医院监控计划,以快速识别此类事件的增加,并确定与此类感染相关的因素,防止出现更多感染。
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引用次数: 1
State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2018–2022 2018-2022年美国各州医疗补助对戒烟治疗的覆盖范围和获得治疗的障碍
Pub Date : 2024-04-11 DOI: 10.15585/mmwr.mm7314a2
Anne DiGiulio, Michael A. Tynan, A. Schecter, Kisha-Ann S. Williams, Brenna VanFrank
The prevalence of cigarette smoking among U.S. adults enrolled in Medicaid is higher than among adults with private insurance; more than one in five adults enrolled in Medicaid smokes cigarettes. Smoking cessation reduces the risk for smoking-related disease and death. Effective treatments for smoking cessation are available, and comprehensive, barrier-free insurance coverage of these treatments can increase cessation. However, Medicaid treatment coverage and treatment access barriers vary by state. The American Lung Association collected and analyzed state-level information regarding coverage for nine tobacco cessation treatments and seven access barriers for standard Medicaid enrollees. As of December 31, 2022, a total of 20 state Medicaid programs provided comprehensive coverage (all nine treatments), an increase from 15 as of December 31, 2018. Only three states had zero access barriers, an increase from two; all three also had comprehensive coverage. Although states continue to improve smoking cessation treatment coverage and decrease access barriers for standard Medicaid enrollees, coverage gaps and access barriers remain in many states. State Medicaid programs can improve the health of enrollees who smoke and potentially reduce health care expenditures by providing barrier-free coverage of all evidence-based cessation treatments and by promoting this coverage to enrollees and providers.
参加医疗补助计划的美国成年人吸烟率高于参加私人保险的成年人;每五个参加医疗补助计划的成年人中就有一个以上吸烟。戒烟可降低与吸烟相关的疾病和死亡风险。目前已有有效的戒烟治疗方法,对这些治疗方法进行全面、无障碍的保险可提高戒烟率。然而,各州的医疗补助治疗覆盖范围和治疗障碍各不相同。美国肺脏协会收集并分析了各州有关九种戒烟治疗的保险范围以及标准医疗补助计划参保者的七种治疗障碍的信息。截至 2022 年 12 月 31 日,共有 20 个州的医疗补助计划提供了全面覆盖(所有九种治疗),比截至 2018 年 12 月 31 日的 15 个州有所增加。只有 3 个州实现了零准入障碍,比之前的 2 个州有所增加;这 3 个州也都实现了全面覆盖。尽管各州继续改善戒烟治疗的覆盖面,减少标准医疗补助计划参保者的就医障碍,但许多州仍存在覆盖缺口和就医障碍。各州医疗补助计划可以通过为所有循证戒烟治疗提供无障碍承保,并向参保者和医疗服务提供者推广这一承保范围,从而改善吸烟参保者的健康状况,并可能减少医疗支出。
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引用次数: 0
Surveillance To Track Progress Toward Polio Eradication — Worldwide, 2022–2023 跟踪根除脊髓灰质炎进展情况的监测--全球,2022-2023 年
Pub Date : 2024-04-04 DOI: 10.15585/mmwr.mm7313a1
Nishant Kishore, Elizabeth Krow-Lucal, O. Diop, J. Jorba, Tigran Avagnan, Varja Grabovac, A. Kfutwah, T. Johnson, Sudhir Joshi, L. Sangal, S. Sharif, Ashraf Wahdan, G. Tallis, Stephanie D Kovacs
The reliable and timely detection of poliovirus cases through surveillance for acute flaccid paralysis (AFP), supplemented by environmental surveillance of sewage samples, is a critical component of the polio eradication program. Since 1988, the number of polio cases caused by wild poliovirus (WPV) has declined by >99.9%, and eradication of WPV serotypes 2 and 3 has been certified; only serotype 1 (WPV1) continues to circulate, and transmission remains endemic in Afghanistan and Pakistan. This surveillance update evaluated indicators from AFP surveillance, environmental surveillance for polioviruses, and Global Polio Laboratory Network performance data provided by 28 priority countries for the program during 2022-2023. No WPV1 cases have been detected outside of Afghanistan and Pakistan since August 2022, when an importation into Malawi and Mozambique resulted in an outbreak during 2021-2022. During 2022-2023, among 28 priority countries, 20 (71.4%) met national AFP surveillance indicator targets, and the number of environmental surveillance sites increased. However, low national rates of reported AFP cases in priority countries in 2023 might have resulted from surveillance reporting lags; substantial national and subnational AFP surveillance gaps persist. Maintaining high-quality surveillance is critical to achieving the goal of global polio eradication. Monitoring surveillance indicators is important to identifying gaps and guiding surveillance-strengthening activities, particularly in countries at high risk for poliovirus circulation.
通过对急性弛缓性麻痹(AFP)的监测,并辅以对污水样本的环境监测,及时可靠地发现脊髓灰质炎病毒病例,是根除脊髓灰质炎计划的重要组成部分。自 1988 年以来,由脊髓灰质炎野病毒 (WPV) 引起的脊髓灰质炎病例数量下降了 >99.9%,WPV 血清型 2 和 3 已被证实根除;只有血清型 1 (WPV1) 仍在流行,并且在阿富汗和巴基斯坦仍有地方性传播。本次监测更新评估了 28 个优先国家在 2022-2023 年期间为该计划提供的 AFP 监测指标、脊髓灰质炎病毒环境监测指标和全球脊髓灰质炎实验室网络绩效数据。自 2022 年 8 月以来,阿富汗和巴基斯坦以外的地区未发现 WPV1 病例,2021-2022 年期间,马拉维和莫桑比克的输入导致了疫情爆发。2022-2023 年期间,在 28 个优先国家中,有 20 个国家(71.4%)达到了国家甲胎蛋白监测指标目标,环境监测点的数量也有所增加。然而,2023 年优先国家报告的甲胎蛋白病例率较低,这可能是由于监测报告滞后造成的;国家和国家以下一级的甲胎蛋白监测仍存在巨大差距。保持高质量的监测对于实现全球根除脊髓灰质炎的目标至关重要。监测指标对于发现差距和指导加强监测活动非常重要,尤其是在脊灰病毒传播高风险国家。
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引用次数: 0
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Morbidity and Mortality Weekly Report
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