Public Health Reports最新文献

Objectives: The risk for mpox virus (MPXV) transmission in most workplaces has not been thoroughly assessed in the context of the 2022 global mpox outbreak. Our objectives were to describe mpox case patients who worked while infectious and the subsequent workplace contact tracing efforts, risk assessments, and outcomes.

Methods: The Centers for Disease Control and Prevention requested information from health departments in the United States in September 2022 to identify people with confirmed or probable mpox who worked outside the home while infectious, either before or after diagnosis, from June 1 through August 31, 2022. We collected and summarized data on demographic, clinical, and workplace characteristics of case patients and workplace contact investigations. We stratified data by industry and occupation categories.

Results: In total, 102 case patients were reported by 6 jurisdictions. The most common industries were accommodation and food services (19.8%) and professional business, management, and technical services (17.0%). Contact investigations identified 178 total contacts; 54 cases (52.9%) had no contacts identified. Of 178 contacts, 54 (30.3%) were recommended to receive postexposure prophylaxis (PEP) and 18 (10.1%) received PEP. None of the contacts developed a rash or were tested for orthopox or mpox, and none were reported to have confirmed or probable mpox.

Conclusion: Data from 6 jurisdictions suggest that the risk of MPXV transmission from workers to others in workplace settings in many industries is low. These findings might support future updates to exposure risk classifications and work activity recommendations for patients. These findings also demonstrate the importance of collecting and analyzing occupation and industry data in case reports to better understand risks in workplaces.

Objective: Throughout the COVID-19 pandemic, the effectiveness of face mask mandates was intensely debated. The objective of this study was to describe how face mask mandates at the state, county, and local levels differed in their effectiveness in reducing the number of COVID-19 cases in the jurisdiction where the mandate was implemented and throughout Utah.

Methods: We used publicly available data from the Utah Department of Health and Human Services. We calculated the effectiveness of face mask mandates (E_Fm) in each local health district after 3 key mandates: the enactment of face mask mandates in Salt Lake and Summit counties (SLSC) on June 28, 2020, and June 27, 2020, respectively; the enactment of a statewide face mask mandate on November 9, 2020; and the lifting of the statewide face mask mandate on April 10, 2021.

Results: Most counties in Utah had a reduction in the growth rate of COVID-19 cases after enactment of face mask mandates. We found an average 11.9% reduction in E_Fm after the introduction of the SLSC face mask mandates, with 8 of 13 local health districts experiencing a reduction, and an average 12.7% reduction after introduction of the statewide mandate, with 12 of 13 local health districts experiencing a reduction. After mandates were lifted, many counties had an increase in E_Fm.

Conclusion: Face mask mandates were an effective way to reduce transmission of COVID-19 in local jurisdictions and in neighboring jurisdictions in Utah. Our evidence supports the use of face mask mandates as a way to prevent disease transmission and be better equipped to respond to future pandemics.

Objectives: Occupational health surveillance programs have rarely incorporated syndromic surveillance. We documented a process for evaluating and revising syndromic surveillance definitions, using the example of work-related emergency department (ED) visits.

Materials and methods: Of 140 331 481 ED visits in the National Syndromic Surveillance Program from May 15, 2016, through October 31, 2017, we extracted 391 827 records for phase 1 that met the previously unevaluated original work-related definition or included a work-related employment status ICD-10-CM code (Y99.0/Y99.1; International Classification of Diseases, Tenth Revision, Clinical Modification). Also for phase 1, we evaluated the performance of the original work-related definition using ICD-10-CM work-related employment status codes as a reference standard. In phase 2, we extracted 99 109 records containing candidate work-related keywords. Finally, in phase 3, we examined individual keywords and developed and evaluated a revised definition.

Results: The revised work-related definition identified 259 153 visits by keyword alone, 104 342 visits by ICD-10-CM work-related employment status codes alone, and 16 385 ED visits by both methods. Sensitivity (13.6% vs 11.3%) and positive predictive value (5.9% vs 4.8%) were higher for the revised definition than for the original work-related definition. Manual review indicated that 91.3% (95% CI, 89.6%-93.0%) of visits identified by the revised definition keywords met the study criteria for work-related visits as compared with 75.5% (95% CI, 73.0%-78.4%) of visits for the original work-related definition.

Practice implications: The original work-related definition performed suboptimally because keywords were not sufficiently specific. The revised definition is an improvement but requires testing in real-world scenarios. The presented methods for developing a syndromic surveillance definition are useful, not only for occupational health, but for identification of other subpopulations treated in the ED.

Objectives: Prenatal alcohol exposure poses a substantial risk to fetal development. Efforts were made in 2011-2020 to increase public awareness of and prevent alcohol consumption during pregnancy. We conducted a cross-sectional survey in Israel of pregnant women's alcohol consumption from January 2021 through June 2023 and compared our results with the results of a survey conducted during 2009-2010 to assess changes over time.

Methods: We conducted cross-sectional surveys at 3 public hospitals in central and northern Israel. Surveyors visited hospitals twice weekly and used a questionnaire consistent with one used in 2009-2010 that focused on alcohol consumption 3 months before pregnancy and during pregnancy. We conducted a stratified analysis of the prevalence of alcohol consumption during pregnancy by demographic characteristics. We also used a multivariable logistic regression model to examine variables associated with receiving guidance on alcohol consumption during pregnancy.

Results: Of 1915 women in the 2021-2023 survey (mean [SD] age, 30.8 [5.6] y), 1204 (62.9%) reported never consuming alcohol before pregnancy and 1708 (89.2%) reported no alcohol consumption during pregnancy. During pregnancy, 157 (8.2%) women reported consuming alcohol weekly or less, 12 (0.6%) more frequently, and 52 (2.7%) binge drinking. We found a significant decrease in alcohol consumption during pregnancy in 2021-2023 as compared with 2009-2010 (odds ratio, 0.68; 95% CI, 0.52-0.88; P = .03). Predictors of alcohol consumption during pregnancy included alcohol consumption before pregnancy, parity, and smoking. Significantly more women in the 2021-2023 sample (n = 569; 29.7%) than in the 2009-2010 sample received guidance on alcohol consumption during pregnancy (P < .001).

Conclusions: Educational efforts should continue to increase awareness of the risks of prenatal alcohol exposure in the general population and among health professionals.

Objectives: The relationship between the onset of the COVID-19 pandemic and interest in master of public health (MPH) programs is unknown. We examined trends in MPH application rates for 31 MPH concentrations and specifically for the MPH concentration in epidemiology and differences by race and ethnicity before and after the onset of the COVID-19 pandemic.

Methods: We constructed a quasi-experimental design to examine trends in MPH application rates from academic years 2015-2016 through 2022-2023 by using Centralized Application Service for Schools and Programs of Public Health data. We used an interrupted time-series analysis to test whether application rates surged after the pandemic's onset (academic years 2019-2020 through 2020-2021) and whether this increase persisted during the pandemic (academic years 2020-2021 through 2022-2023). We fit models for the overall sample, a combined racially and ethnically minoritized sample, each racial and ethnic group separately, and a non-US citizen sample.

Results: The pandemic's onset correlated with an immediate increase in application rates across most samples: overall (38%) and among American Indian/Alaska Native/Native Hawaiian/Pacific Islander (91%), Asian (35%), Black (42%), Hispanic (60%), multiracial (30%), racially and ethnically minoritized (44%), and White (53%) samples. However, this trend was not sustained; application rate trends during the pandemic were significantly lower than prepandemic trends. Application rate trends for all MPH concentrations and the MPH in epidemiology concentration among non-US citizens were significantly higher during the pandemic than prepandemic.

Conclusions: Our results highlight the need for innovative strategies to sustain MPH degree interest and a diverse applicant pool.

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age that influence health outcomes, and structural and systemic drivers of health (SSD) are the social, cultural, political, and economic contexts that create and shape SDOH. With the integration of constructs from previous examples, we propose an SSD model that broadens the contextual effect of these driving forces or factors rooted in the Centers for Disease Control and Prevention's SDOH framework. Our SSD model (1) presents systems and structures as multidimensional, (2) considers 10 dimensions as discrete and intersectional, and (3) acknowledges health-related effects over time at different life stages and across generations. We also present an application of this SSD model to the housing domain and describe how SSD affect SDOH through multiple mechanisms that may lead to unequal resources, opportunities, and consequences contributing to a disproportionate burden of disease, illness, and death in the US population. Our enhanced SDOH framework offers an innovative and promising model for multidimensional, collaborative public health approaches toward achieving health equity and eliminating health disparities.

The COVID-19 pandemic challenged school health professionals to navigate a dynamic public health emergency and to stay aware of changing recommendations. This study aimed to determine the value of the COVID Just-in-Time ECHO (Extension for Community Health Outcomes) Learning Series for Schools among participating school health personnel and to describe their ongoing information needs during the pandemic. School health, public health, and education professionals across Colorado participated in this ECHO series. Participants attended 1-hour sessions every 2 to 4 weeks from March 2020 through December 2021 for a total of 34 sessions. Data collection included postsession and postseries surveys assessing what participants found most valuable and what additional information they needed. School nurses represented 113 of 224 participants (50%). ECHO content noted as being the most valuable included epidemiology updates and special topics as chosen by participant input. Postseries surveys identified the value of experiencing shared knowledge among Just-in-Time ECHO participants. Participants identified ongoing needs for information about COVID-19 guidance and risk mitigation in schools throughout the sessions. In postseries surveys, participants reported additional ongoing information needs related to COVID-19 outside schools. This ECHO series delivered reliable and time-sensitive information for school health personnel and school leaders and may provide a useful model for information sharing among education and public health professionals.

In 2021, the US government undertook Operation Allies Welcome, in which evacuees from Afghanistan arrived at 2 US ports of entry in Virginia and Pennsylvania. Because of the rapid evacuation process, the US government granted evacuees an exemption to a Centers for Disease Control and Prevention (CDC) requirement in place at that time-namely, that air passengers present a negative SARS-CoV-2 viral test result or documentation of recovery from COVID-19 before they boarded international flights bound for the United States. This study describes cases of SARS-CoV-2 infection detected among 65 068 evacuees who arrived at the 2 ports of entry in August and September 2021. Because evacuees were a population at increased risk for infection with diseases of public health concern, CDC staff helped coordinate on-site and on-arrival testing, visually observed evacuees for signs and symptoms of communicable disease, and referred evacuees for further evaluation and treatment as needed. CDC staff used antigen or nucleic acid amplification tests at the ports of entry to evaluate evacuees aged ≥2 years without documentation of recent SARS-CoV-2 infection. CDC staff isolated evacuees with confirmed SARS-CoV-2 infection and quarantined their close contacts, consistent with CDC guidance at the time, before evacuees rejoined the repatriation process. Of 65 068 evacuees, 214 (0.3%) were confirmed as having SARS-CoV-2 infection after port-of-entry testing. Cases of measles, varicella, pertussis, tuberculosis, hepatitis A, malaria, leishmaniasis, and diarrheal illness were also identified. Although the percentage of SARS-CoV-2 infection was low in this evacuated population, communicable disease detection at US ports of entry, along with vaccination efforts, was an important part of a multilayered approach to mitigate the transmission of disease in congregate housing facilities and into US communities.

Objectives: The HealthPartners' Vaccine Safety Datalink (VSD) team maintains standardized files of vaccines from medical and pharmacy claims and electronic health records (established data sources) for safety surveillance. Since 2021, for selected vaccines, data from the Minnesota Immunization Information Connection (MIIC), Minnesota's immunization information system, have been added to the HealthPartners' VSD files. We examined how MIIC data have enhanced the identification of novel and routine vaccines.

Methods: We describe the approach to incorporating MIIC data. We determined and compared the number and proportion of vaccines identified from established data sources with the additional capture of vaccine data identified from MIIC, in which age group and period of observation varied by vaccine.

Results: As of December 31, 2023, of 1 099 411 people in the HealthPartners' VSD cohort, 1 001 400 people (91%) were linked with an MIIC record. Across all data sources, for the full cohort, >2.7 million COVID-19 vaccine doses were recorded since 2020, >4000 mpox vaccine doses since 2022, >7.3 million influenza vaccine doses since 2004, >600 000 human papillomavirus (HPV) vaccine doses since 2006, and >1.1 million diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine doses since 2004. For COVID-19 vaccines, about 30% of vaccine doses were exclusively captured from MIIC, with the remaining 70% from established data sources. For the mpox vaccine, about 42% were exclusively from MIIC. For influenza, HPV, and DTaP vaccines, about 20%, 14%, and 17%, respectively, were exclusively identified from MIIC.

Conclusions: Incorporation of data from state immunization information systems into existing vaccine data files can enhance monitoring on the safety of novel vaccines administered outside traditional health care settings and can enhance data quality for routine childhood and adult vaccines.