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Background: Maternal vaccine coverage is suboptimal, and a substantial proportion of parents have concerns about vaccines. Most parents seek out vaccine information during and immediately after their first pregnancy. No study to our knowledge has analyzed survey data to identify homogeneous groups of pregnant women based on their vaccine attitudes and beliefs. Aims: To identify homogeneity among groups of pregnant women based on their vaccine attitudes and beliefs to facilitate audience segmentation and targeting of tailored educational interventions. Method: Between June 2017 and July 2018, we surveyed 2,196 pregnant women recruited from geographically and sociodemographically diverse prenatal care practices in Georgia and Colorado. We then performed a latent class analysis to identify homogeneity among groups of pregnant women. Results: Our latent class analysis produced three groups of pregnant women: vaccine supporters (36% of women), vaccine acceptors (41%), and vaccine skeptics (23%). Discussion: The major difference between the supporters and the acceptors were whether they mostly "strongly agreed" or just "agreed" to Likert-type scale survey items assessing their vaccine attitudes and beliefs. The skeptics most frequently chose "disagree" or "don't know" for items assessing attitudinal constructs such as confidence in vaccine safety and efficacy and disease susceptibility. However, even skeptics often chose "agree" for items assessing constructs such as disease severity and self-efficacy. Conclusions: This article provides useful insight into the homogeneity among groups of pregnant women based on their vaccine attitudes and beliefs. This knowledge should help facilitate audience segmentation and targeting of tailored educational interventions among this population.

Animals exhibit pronounced age‐based shifts in habitat selection, often because of increasing body size. Body size affects how animals access resources, traverse landscapes, and perceive predation risk. While adults may be habitat generalists, offspring may be constrained by diet, predation avoidance methods, and mobility given smaller body size, and thus be more specialized. Observed declines in eastern wild turkey (Meleagris gallopavo silvestris) productivity and recruitment across the southeastern United States has necessitated evaluations of availability and composition of brood habitat. As poults are smaller and have more specialized resource requirements than adults, selection of vegetation likely changes as poults age. We evaluated aged‐based shifts in selection relative to vegetation communities, normalized difference vegetation indices (NDVI), and distances to trails by eastern wild turkey brooding females in a pine (Pinus spp.)‐dominated landscape in Georgia, USA, from April–July during 2017–2020. We used step‐selection functions and conditional logistic regression to evaluate resource selection of 36 brooding females. Of 175 nests monitored, 36 (20.6%) successfully hatched a brood and only 12 broods had at least 1 poult survive ≥28 days post‐hatch (i.e., 6.9% of nests produced a poult that was recruited into the population). Overall, brooding females selected for pastures (β = 0.730; 95% CI = 0.5144–0.9452), hardwoods (β = 0.324; 95% CI = 0.1608–0.4865), areas closer to trails (β = −0.002; 95% CI = −0.0023–−0.0014), and areas with greater NDVI values (β = 2.714; 95% CI = 1.7897–3.6380). Habitat selection shifted as broods aged, suggesting resource needs shift to scale allometrically with body size as broods get older. For example, selection strength waned as broods aged and broods were 2.47 times less likely to select pastures on day 28 relative to day 1 post‐hatch. Pastures were selected for after broods hatched, whereas selection for young pines increased as poults aged. Despite pine‐dominated cover types comprising nearly a third of the usable landscape, young pine communities were avoided by females with recently hatched broods. Managers may create better brood habitat by promoting early successional vegetation communities amidst a diversity of other land cover types to account for changing resource needs and predator avoidance capabilities as poults age. [ABSTRACT FROM AUTHOR]

Context: Numerous wildlife species use a polygynous mating system, where males use auditory courtship behaviors to secure breeding opportunities. The acoustic adaptation hypothesis, risk reward, and landscape of fear theories suggest spatial variation in male auditory courtship will be influenced by areas in landscapes where sound transmission is increased, and predation risk is reduced. However, it is often unclear what landscape features drive spatial variation in courtship behaviors. Objectives: We quantified the influence of predation risk, land cover type, and resource selection on spatial trends in the auditory courtship behavior (gobbling activity) of Eastern wild turkeys (Meleagris gallopavo silvestris). Methods: We used 53,025 gobbles coupled with GPS locations from 111 turkeys and 36 coyotes (Canis latrans), and distance metrics associated with hunter activity and land cover type, to investigate influences of predation risk, resource selection, and land cover type on spatial variation in gobbling activity in Georgia, USA. Results: Distance to public access during hunting was the most influential predictor of gobbling activity, wherein the expected number of daily gobbles increased by 40% for every 500 m farther from public access. Daily gobbles decreased by 22% for every 500 m farther away from private property during hunting. We failed to find significant effects of land cover type and coyote use but found limited evidence that areas with increased predicted probability of turkey use was associated with increased gobbling. Conclusions: Predation risk associated with increased anthropogenic disturbance had the greatest influence on gobbling activity. Our findings suggest that altering hunter access by closing roads to vehicle use, reducing hunter activity, or creating refuge areas on the landscape could positively influence gobbling activity. [ABSTRACT FROM AUTHOR]

Background Contact tracing during the Coronavirus Disease 2019 (COVID-19) pandemic in the USA has been met with various challenges. In an attempt to improve the yield of close contact collection, the Fulton County Board of Health implemented a pilot approach to contact elicitation at the time of testing. Methods Between October and November 2020, close contacts were elicited from persons under investigation (PUIs) at one COVID-19 testing site in Fulton County, GA. Secure online data collection forms were used to record PUI demographic data, close contact information and reasons for not providing contacts. Results Of 1238 PUIs, 48% reported at least one contact. Among the 66 people who tested positive, 16 (24%) reported contacts compared to 578/1165 (50%) who tested negative. PUIs of increasing age were less likely to provide contacts; Black and Hispanic PUIs were also less likely to report any contacts compared to White and Asian PUIs. Conclusions Our study revealed that PUIs testing positive were less likely to provide contacts compared to PUIs testing negative. Age and racial differences were also noted in the provision of contacts. Further investigation is needed to understand these discrepancies in order to devise more effective strategies for contact elicitation. [ABSTRACT FROM AUTHOR]

Background: Many pregnant women and parents have concerns about vaccines. This analysis examined the impact of MomsTalkShots, an individually tailored educational application, on vaccine attitudes of pregnant women and mothers. Methods: MomsTalkShots was the patient-level component of a multi-level intervention to improve maternal and infant vaccine uptake that also included provider- and practice-level interventions. The impact of these interventions was studied using a two-by-two factorial design, randomizing at both the patient- and the practice-level. Study staff recruited pregnant women from a diverse set of prenatal care practices in Colorado and Georgia between June 2017 and July 2018. All participants (n = 2087) received a baseline survey of maternal and infant vaccine intentions and attitudes, and two follow-up surveys at least 1 month and 1 year after their infant's birth, respectively. Half of participants (n = 1041) were randomly assigned to receive educational videos through MomsTalkShots, algorithmically tailored to their vaccine intentions, attitudes, and demographics. Since the practice/provider intervention did not appear impactful, this analysis focused on MomsTalkShots regardless of the practice/provider intervention. Results: By 1 month post-birth, MomsTalkShots increased perceived risk of maternal influenza disease (61% among MomsTalkShots recipients vs 55% among controls; Odds Ratio: 1.61, 95% Confidence Interval: 1.23–2.09), confidence in influenza vaccine efficacy (73% vs 63%; OR: 1.97, 95%CI: 1.47–2.65), and perceived vaccine knowledge (55% vs 48%; OR: 1.39, 95%CI: 1.13–1.72). Among those intending not to vaccinate at baseline, MomsTalkShots increased perceived risk of maternal influenza disease (38% vs 32%; OR: 2.07, 95%CI: 1.15–3.71) and confidence in influenza vaccine efficacy (44% vs 28%; OR: 2.62, 95%CI: 1.46–4.69). By 1 year post-birth, MomsTalkShots increased perceived vaccine knowledge (62% vs 50%; OR: 1.74, 95%CI: 1.36–2.24) and trust in vaccine information from obstetricians and pediatricians (64% vs 55%; OR: 1.53, 95%CI: 1.17–2.00). Among those uncertain about vaccinating at baseline, MomsTalkShots increased perceived vaccine knowledge (47% vs 12%; OR: 6.89, 95%CI: 1.52–31.25) and reduced infant vaccine safety concerns (71% vs 91%; OR: 0.24, 95%CI: 0.06–0.98). Conclusions: MomsTalkShots improved pregnant women's and mothers' knowledge and perceptions of maternal and infant vaccines and the diseases they prevent, and offers a scalable tool to address vaccine hesitancy. Trial registration: Registered at Clinicaltrials.gov on 13/09/2016 (registration number: NCT02898688). [ABSTRACT FROM AUTHOR]

Background: Reported coronavirus disease 2019 (COVID-19) cases underestimate true severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Data on all infections, including asymptomatic infections, are needed. To minimize biases in estimates from reported cases and seroprevalence surveys, we conducted a household-based probability survey and estimated cumulative incidence of SARS-CoV-2 infections adjusted for antibody waning.Methods: From August to December 2020, we mailed specimen collection kits (nasal swabs and blood spots) to a random sample of Georgia addresses. One household adult completed a survey and returned specimens for virus and antibody testing. We estimated cumulative incidence of SARS-CoV-2 infections adjusted for waning antibodies, reported fraction, and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic, and clinical subgroups were explored with weighted prevalence ratios (PR).Results: Among 1370 participants, adjusted cumulative incidence of SARS-CoV-2 was 16.1% (95% credible interval [CrI], 13.5%-19.2%) as of 16 November 2020. The reported fraction was 26.6% and IFR was 0.78%. Non-Hispanic black (PR, 2.03; 95% confidence interval [CI], 1.0-4.1) and Hispanic adults (PR, 1.98; 95% CI, .74-5.31) were more likely than non-Hispanic white adults to be seropositive.Conclusions: As of mid-November 2020, 1 in 6 adults in Georgia had been infected with SARS-CoV-2. The COVID-19 epidemic in Georgia is likely substantially underestimated by reported cases. [ABSTRACT FROM AUTHOR]

Objectives: Although disparities in maternal vaccine acceptance among racial/ethnic groups are well documented, the reasons for these disparities are unclear. The objective of this study was to describe differences in pregnant women's knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines by race/ethnicity. Methods: We collected survey data from 1862 pregnant women from diverse prenatal care practices in Georgia and Colorado from June 2017 through July 2018. We performed multiple logistic regressions to determine differences in intentions, knowledge, attitudes, beliefs, and trust by race/ethnicity and calculated odds ratios (ORs) and 95% CIs. Results: Compared with White women, Black and Hispanic women were less confident in vaccine safety and efficacy and less likely to perceive risk of acquiring vaccine-preventable diseases, report provaccine social norms, indicate having enough vaccine knowledge, and trust vaccine information from health care providers and public health authorities. Black women were the least confident in the safety of the maternal influenza vaccine (OR = 0.37; 95% CI, 0.27-0.49); maternal tetanus, diphtheria, and acellular pertussis vaccine (OR = 0.37; 95% CI, 0.27-0.52); and infant vaccines overall (OR = 0.40; 95% CI, 0.28-0.58), and were least likely to intend to receive both maternal vaccines (OR = 0.35; 95% CI, 0.27-0.47) or all infant vaccines on time (OR = 0.45; 95% CI, 0.34-0.61) as compared with White women. Conclusions: Understanding differences in behavioral constructs integral to vaccine decision making among women of different races/ethnicities can lead to tailored interventions to improve vaccine acceptance. [ABSTRACT FROM AUTHOR]

Objective: To determine the willingness to discuss and be screened for pre-exposure prophylaxis (PrEP) in pharmacies among MSM. Methods: Led by Georgia's Fulton County Board of Health, this study surveyed individuals who attended 2 Atlanta-based Gay Pride events in 2018. This analysis was limited to those who identified as men who have sex with men (MSM) who were not HIV positive and reported never using PrEP. Multivariable regression was used to determine the correlates of willingness to discuss and be screened for PrEP in-pharmacy. Results: Most (69%) were willing to discuss PrEP with pharmacy staff and 61.35% were willing to be screened for PrEP in-pharmacy. Those who were interested in PrEP were significantly more willing to discuss PrEP in-pharmacy compared to those not interested in PrEP (prevalence ratio [PR]: 1.65; 95% confidence interval [95% CI]: 1.11-2.48). Race was not associated with willingness to discuss PrEP with pharmacy staff. However, black MSM (BMSM) were less willing to be screened in pharmacies than white MSM, until we accounted for interest in PrEP (PR: 1.27; 95% CI: 1.09-1.48). Discussion: Pharmacies may be an optimal setting to expand PrEP access to reach racial minorities who have the highest need but are not being reached. Pharmacy-based PrEP discussions and screening could improve awareness of HIV status and increase PrEP knowledge and uptake. Future studies should determine optimal pharmacy conditions under which PrEP screening and uptake are acceptable for BMSM. [ABSTRACT FROM AUTHOR]

In canids, resident breeders hold territories but require different resources than transient individuals (i.e., dispersers), which may result in differential use of space, land cover, and food by residents and transients. In the southeastern United States, coyote (Canis latrans) reproduction occurs during spring and is energetically demanding for residents, but transients do not reproduce and therefore can exhibit feeding behaviors with lower energetic rewards. Hence, how coyotes behave in their environment likely differs between resident and transient coyotes. We captured and monitored 36 coyotes in Georgia during 2018-2019 and used data from 11 resident breeders, 12 predispersing residents (i.e., offspring of resident breeders), and 11 transients to determine space use, movements, and relationships between these behaviors and landcover characteristics. Average home range size for resident breeders and predispersing offspring was 20.7 ± 2.5 km² and 50.7 ± 10.0 km², respectively. Average size of transient ranges was 241.4 ± 114.5 km². Daily distance moved was 6.3 ± 3.0 km for resident males, 5.5 ± 2.7 km for resident females, and 6.9 ± 4.2 km for transients. We estimated first-passage time values to assess the scale at which coyotes respond to their environment, and used behavioral change-point analysis to determine that coyotes exhibited three behavioral states. We found notable differences between resident and transient coyotes in regard to how landcover characteristics influenced their behavioral states. Resident coyotes tended to select for areas with denser vegetation while resting and foraging, but for areas with less dense vegetation and canopy cover when walking. Transient coyotes selected areas closer to roads and with lower canopy cover while resting, but for areas farther from roads when foraging and walking. Our findings suggest that behaviors of both resident and transient coyotes are influenced by varying landcover characteristics, which could have implications for prey. [ABSTRACT FROM AUTHOR]

Habitat fragmentation and loss contribute to isolation of wildlife populations and increased extinction risks for various species, including many large carnivores. We studied a small and isolated population of American black bears (Ursus americanus) that is of conservation concern in central Georgia, USA (i.e., central Georgia bear population [CGBP]). Our goal was to evaluate the potential for demographic and genetic interchange from neighboring bear populations to the CGBP. To evaluate resource selection and movement potential, we used 35,487 global positioning system locations collected every 20 minutes from 2012 to 2014 from 33 male bears in the CGBP. We then developed a step selection function model based on conditional logistic regression. Male bears chose steps that avoided crops, roads, and human developments and were closer to forests and woody wetlands than expected based on availability. We used a geographic information system to simulate 300 bear movement paths from nearby bear populations in northern Florida, northern Georgia, and southern Georgia to estimate the potential for immigration to the CGBP. Only 4 simulated movement paths from the nearby populations intersected the CGBP. The creation of a hypothetical 1‐km‐wide corridor between the southern Georgia population and the CGBP produced only minor improvements in interchange. Our findings suggest that demographic connectivity between the CGBP and surrounding bear populations may be limited, and coupled with previous works showing genetic isolation in the CGBP, that creation of corridors may have only marginal effects on restoring gene flow, at least in the near term. Management actions such as translocation and the establishment of stepping stone populations may be needed to increase the genetic diversity and demographic stability of bears in the CGBP. © 2021 The Wildlife Society. : Demographic connectivity between the central Georgia bear population (CGBP) and surrounding bear populations may be limited, and creation of corridors may have only marginal effects on restoring gene flow. Management actions such as translocation and the establishment of stepping stone populations may be needed to increase the genetic diversity and demographic stability of bears in the CGBP. [ABSTRACT FROM AUTHOR]

The Central Georgia Bear Population (CGP) is the least abundant and most isolated of Georgia's 3 American black bear (Ursus americanus) populations. Beginning in 2011, changes to regulations governing harvest of the CGP resulted in an increase in female bear harvest, creating concern that future harvest could be an important influence on population viability. Hence, our objective was to assess viability of the CGP under various levels of female mortality. During 2012–2016, we used barbed‐wire hair snares to collect bear hair samples from within the range of the CGP in Georgia, USA. We used microsatellite genotyping to identify individual bears and created robust‐design, spatial detection histories for all female bears detected. We fit open population spatial capture‐recapture (SCR) models to the detection histories in a Bayesian framework. We used the Widely Applicable Information Criterion (WAIC) to rank models that varied with respect to sources of variation in detection probability, survival, and per capita recruitment, and used the model with the lowest WAIC to forecast dynamics of the CGP 50 years into the future under various levels of female mortality. We assessed the 50‐year extinction probability under a continuation of mortality levels documented during 2012–2016, and under incremental increases in female mortality above this baseline. The top model included density‐dependent per capita recruitment, annual variation in detection probability, and a trap‐level behavioral response. Abundance increased from 106 (95% CI = 86–132) females in 2012 to 136 (95% CI = 113–161) females in 2013 and remained relatively stable thereafter. Annual female survival was 0.75 (95% CI = 0.69–0.82) and did not vary among years. The per capita recruitment rate decreased over time as density increased, and was 0.49 (95% CI = 0.33–0.66) during the first time interval and 0.29 (95% CI = 0.20–0.38) during the final time interval. Annual growth rate (λt) was 1.28 (95% CI = 1.07–1.52) between 2012 and 2013 but decreased throughout the study, ending at 1.04 (95% CI = 0.93–1.17). Forecasts indicated continuation of the female mortality levels experienced from 2012–2016 were sustainable over 50 years, with the estimated extinction risk being <0.001%. Increasing annual harvest by 5 females introduced a negligible increase in the 50‐year probability of extinction, but harvesting an additional 10 females/year caused extinction risk to rise to 1.15%. We recommend that harvest regulations are structured such that mortality rates remain at current levels or do not increase by more than an annual average of 5 females above levels observed during our study. Furthermore, we recommend that managers continue to monitor the population so that harvest regulations and population models can be refined over time. © 2020 The Wildlife Society. We found that increasing annual harvest by 5 females in a black bear population introduced a negligible increase in the 50‐year probability of extinction, but harvesting an additional 10 females/year caused extinction risk to rise to 1.15%. We recommend that harvest regulations be structured such that mortality rates remain at current levels or do not increase by more than an annual average of 5 females above levels observed during our study. [ABSTRACT FROM AUTHOR]

Objective: To describe factors associated with not being tested for Chlamydia trachomatis and Neisseria gonorrhea infection during pregnancy and for testing positive and to describe patterns of treatment and tests of reinfection.Methods: We conducted a retrospective cohort study of women who delivered at an urban teaching hospital from July 1, 2016 to June 30, 2018. Women with at least one prenatal care or triage visit were included. The index delivery was included for women with multiple deliveries. We used logistic regression to analyze factors associated with not being tested and for testing positive for these infections in pregnancy. Cox proportional hazards models were used to examine factors associated with time to treatment and tests of reinfection. We reviewed medical records to determine reasons for delays in treatment longer than 1 week.Results: Among 3,265 eligible deliveries, 3,177 (97%) women were tested during pregnancy. Of these, 370 (12%) tested positive (287 chlamydia, 35 gonorrhea, 48 both), and 15% had repeat infections. Prenatal care adequacy and insurance status were risk factors for not being tested. Age, race and ethnicity, alcohol use, and sexually transmitted infection history were associated with testing positive. Time to treatment ranged from 0 to 221 days, with the majority (55%) of patients experiencing delays of more than 1 week. Common reasons for delays included lack of clinician recognition and follow-up of abnormal results (65%) and difficulty contacting the patient (33%).Conclusion: Traditional risk factors are associated with increased risk of infection during pregnancy. Prenatal care adequacy and insurance status were associated with the likelihood of being tested. Delays in treatment and tests of reinfection were common. Point-of-care testing and expedited partner therapy should be explored as ways to improve the management of these infections in pregnancy. [ABSTRACT FROM AUTHOR]

Roosting is an important component of wild turkey (Meleagris gallopavo; turkey) ecology as roosts provide security from predators and inclement weather. Males call (gobble) from roosts during the reproductive season, and roost locations are important for maximizing access to females and transmission of calls across the landscape, while also minimizing predation risk. Spring hunting of male turkeys occurs during the reproductive season, and hunting activity influences male behaviors and calling. Because roost sites are important for wild turkey ecology, we evaluated roost site selection and fidelity of male turkeys relative to land cover types, vegetative characteristics, and the presence of hunting activity during 2017–2018 in Georgia, USA. Prior to onset of hunting, males selected roosts nearest to hardwood and pine (Pinus spp.) forests. Roost site fidelity was low and distances between roosts were large. After onset of hunting, males selected pine forests less and exhibited greater plasticity in roost selection while fidelity remained minimal, suggesting that males may have altered selection to mitigate risk from hunting while maintaining the strategy of moving about their ranges and roosting at different sites on consecutive nights. Future research should examine potential effects of hunting‐induced shifts in resource selection on other aspects of male turkey behavior and ecology. © 2019 The Wildlife Society. Our findings suggest that hunting activity had little influence on roost site fidelity, as male wild turkeys exhibited low fidelity to nightly roosts before and after the onset of hunting. However, after hunting began males exhibited greater plasticity in roost selection, suggesting they may have altered selection to mitigate risk from hunting while maintaining the strategy of moving about their ranges and roosting at different sites on consecutive nights. [ABSTRACT FROM AUTHOR]

Wild turkeys (Meleagris gallopavo) use a polygynous mating system whereby males engage in multiple courtship behaviors, including vocalizations (gobbling) to attract females and compete with other males for breeding opportunities. Males must balance the risk of courtship behaviors with the reproductive potential of each courtship behavior. Male turkeys are primarily hunted during the reproductive period, so the associated risk of courtship behaviors is increased. Many state agencies attempt to set hunting season frameworks that maximize hunter satisfaction by allowing hunting when gobbling activity is greatest and most females are theoretically incubating nests, but the relationship between gobbling activity and nesting phenology is unclear. We used autonomous recording units and global positioning system transmitters to monitor gobbling activity by male turkeys and reproductive behaviors of female turkeys in the Piedmont region of Georgia, USA. We used 13,177 gobbles, behavioral data from 82 females during the reproductive season, and daily estimates of harvest of males by hunters to examine relationships between daily gobbling activity, cumulative removal of males, and reproductive behaviors (laying, incubating) of females during 2017–2018. We observed a weak negative relationship between daily gobbling activity and gobbling activity the following day. As the reproductive season progressed, gobbling activity decreased. As the proportion of females engaged in laying or incubating behaviors increased, expected daily gobbling activity increased. Conversely, we observed that hunting and removal of males had a negative effect on daily gobbling activity, and this effect was disproportionately greater than the positive effect of female reproductive behaviors. Our findings suggest that hunting and removal of males are important determinants of gobbling activity, and that corresponding reductions in gobbling activity may have mediating effects on the mating system of wild turkeys. © 2019 The Wildlife Society. Our findings suggest that hunting and removal of male wild turkeys had a negative effect on daily gobbling activity, and this effect was disproportionately greater than the positive effect of female reproductive behaviors. We found that hunting and removal of males were important determinants of gobbling activity, and offer that corresponding reductions in gobbling activity may have mediating effects on the mating system of wild turkeys. [ABSTRACT FROM AUTHOR]

Compared to knowledge about HIV risk factors among men in the south, less is known about risk factors for women. We conducted an individually matched case–control study to identify factors associated with HIV seroconversion among women. Cases had a clinician-assisted visit (CAV) between 2011 and 2016 at an Atlanta-based public health clinic before HIV diagnosis. Controls were women who visited the clinic but remained HIV negative. Controls were matched to cases in a 2:1 ratio on race, age at first CAV, and date of first CAV. Conditional logistic regression was used to develop a best-fitting model for characterizing HIV risk. Of 18,281 women who were HIV negative at their first visit, 110 (0.6%) seroconverted before 2019. Of these, 80 (73%) had a CAV before HIV diagnosis. Having multiple gonorrhea episodes, a syphilis episode, a greater number of sex partners in the past 2 months, anal sex, history of drug use, history of exchanging drugs or money for sex, and heterosexual sex with >1 sex partner in the last month were individually associated with HIV seroconversion. In multivariate analyses, having a syphilis episode [odds ratio (OR) = 4.7, 95% confidence interval (CI): 1.3–16.3], anal sex (OR = 2.8, 95% CI: 1.0–8.1), and injection drug or crack cocaine use (OR = 33.5, 95% CI: 3.6–313.3) remained associated with HIV. Women having all three risk factors were six times more likely to seroconvert compared to women without these factors. Our results offer insights into which women in a southern HIV "hotspot" may be at greatest risk for HIV. [ABSTRACT FROM AUTHOR]

Mottled ducks (Anas fulvigula) were released by the South Carolina Department of Natural Resources (SCDNR) in South Carolina, USA, during 1975–1983 and expanded into Georgia, USA, in the 1990s. Banding data suggest that birds marked in Georgia are often harvested in other states. Because the South Carolina reintroduced population was able to expand into Georgia via long‐distance dispersal, a more thorough understanding of mottled duck spatial ecology in Georgia and South Carolina is needed to direct future management decisions to accommodate expanding duck populations. We used global positioning system (GPS) telemetry to investigate movements and habitat selection by 47 mottled ducks (17 males, 30 females) during 4 seasons from 2013–2016. Mean seasonal home ranges varied from 2,002–4,598 ha across sexes and seasons. We found mean distances moved within seasonal ranges varied from 3.5–11.3 km/day for birds captured in Georgia, and 1.3–5.6 km/day for those captured in South Carolina. We observed 23 excursions, in which individuals left established seasonal ranges for >6 hours and moved ≥5 km; these excursions ranged from 5 km to 139.5 km. We documented 5 dispersals ranging from 52.6 km to 245.8 km. We also documented several long‐distance movements, with 7 birds captured in Georgia moving to South Carolina and 2 moving to Florida, USA. These movements suggest mottled ducks in South Carolina and Georgia may constitute a single population. Notably, we observed dispersal and long‐distance movements only from birds marked in Georgia, suggesting that habitat may be a limiting factor along the Georgia coast. We quantified third‐order selection for mottled ducks and found seasonal selection for managed impoundments and avoidance of palustrine emergent marsh during breeding and teal seasons. Managed impoundments were limited to 4 river systems along coastal Georgia and South Carolina, resulting in much of the coastal wetlands in both states being unused by mottled ducks. We suggest the Georgia Department of Natural Resources (GADNR) and SCDNR work cooperatively to manage mottled ducks and their habitats by focusing efforts to create and manage impoundments throughout the Santee, Savannah, Altamaha, and Ashepoo‐Combahe‐Edisto (ACE) river basins in coastal Georgia and South Carolina where we documented use. © 2018 The Wildlife Society. We observed dispersal and long‐distance movements from birds marked in Georgia to South Carolina and Florida, which may be related to limited managed impoundments. We suggest the Georgia Department of Natural Resources and the South Carolina Department of Natural Resources work cooperatively to manage mottled ducks and their habitats by focusing efforts to create and manage impoundments throughout the Santee, Savannah, Altamaha, and Ashepoo‐Combahe‐Edisto (ACE) River river basins in coastal Georgia and South Carolina. [ABSTRACT FROM AUTHOR]

Understanding habitat selection of gray foxes (Urocyon cinereoargenteus) is essential to evaluate their potential response to changes in land use and predator communities. Few studies have evaluated temporal habitat selection or explicitly identified habitats used by gray foxes for diurnal refugia. We used GPS collars to obtain location data for 34 gray foxes (20 males and 14 females) from February 2014 to December 2015 to evaluate temporal (seasonal and diel) habitat selection and selection of diurnal refugia in southwestern Georgia, USA. We analyzed habitat selection at 2 levels, selection of a core area within the home range and selection of locations within the home range. Habitat selection was non-random (P < 0.001) but consistent among seasons, between day and night, and between sexes (P > 0.05). Hardwoods, human use (i.e., areas associated with regular human activity such as buildings, lawns, parking areas, etc.), and roads were selected (P < 0.05), whereas pine dominated stands were used randomly (P > 0.05). Selection of habitats for diurnal refugia did not vary seasonally or by sex (P > 0.05), with foxes selecting (P < 0.05) areas near hardwood forests, roads, agriculture, human use, pastures/food plots, and shrub scrub habitats. Gray foxes were observed on the ground while resting, and we found no evidence of gray foxes diurnally resting in trees. Our results suggest that on our study area, gray foxes are an edge species that prefer forests with a hardwood component in areas near human use and roads. [ABSTRACT FROM AUTHOR]

Background: Because of the particularly severe perinatal outcomes associated with antenatal Zika virus infection, it is important for prenatal care providers to communicate Zika virus risks and strategies for prevention to their patients. Although face-to-face communication is ideal, clinic visits may not allow for in-depth discussion of all concerns. While previous studies have shown prenatal providers to be pregnant women's most trusted sources of health information, there is little knowledge on what secondary communication modalities pregnant women prefer for receiving information from their providers about an evolving public health emergency.Methods: A cross-sectional, descriptive anonymous 27-item survey was distributed to pregnant women at four clinics around Atlanta, Georgia from May 5th to June 20th, 2016. The survey assessed women's interest in and communication preferences about prenatal topics, including Zika virus. Descriptive statistics were calculated and chi-square tests were used to evaluate associations between the primary outcomes and patient characteristics.Results: Four-hundred and eight women completed the survey. The most popular resource for obtaining Zika virus information was the Centers for Disease Control and Prevention (CDC) website (73.0%). While their prenatal provider's own website for Zika information ranked 5th among sources currently accessed for Zika information, it ranked third behind educational brochures and emails for ways in which women wanted to receive information. The characteristics of Zika virus information deemed most important were: evidence-based (87.5%), endorsed by the CDC (74.1%), and endorsed by their own provider (67.9%).Conclusion: In any public health emergency affecting pregnant women, women are going to seek advice from their obstetric providers. Because providers may lack sufficient time to discuss concerns with every patient, they may consider providing patient education in other ways. For the women included in this study, educational brochures, emails and providers' own practice websites were preferred. Providers should consider taking greater advantage of these modalities to supplement in-person exchanges, particularly during a public health emergency. [ABSTRACT FROM AUTHOR]

Background Considerable research has identified barriers to antenatal influenza vaccination, yet no research has explored temporal trends in reasons for non-receipt. Purpose To examine trends in reasons for non-receipt of influenza vaccination during pregnancy. Methods Serial cross-sectional analyses using 8 years of Georgia Pregnancy Risk Assessment Monitoring Survey (PRAMS) data were conducted. Weighted logistic regression was used to examine trends in the prevalence of citing reasons for non-receipt over time. Results Between 2004 and 2011, 8300 women reported no influenza vaccination during or immediately before pregnancy. Proportions of women citing “doctor didn’t mention vaccination,” “in first trimester during influenza season,” and “not pregnant during influenza season” decreased significantly over time (Doctor didn’t mention: 48.0% vs. 27.1%, test for trend p < 0.001; in first trimester: 26.8% vs. 16.3%, test for trend p < 0.001; not influenza season: 24.2% vs. 12.7%, test for trend p = 0.001). Safety concerns increased over 2004 proportions in 2010 (concern about side effects for me: 40.2% vs. 28.5%, prevalence ratio (PR): 1.41, 95% confidence interval (CI): 1.16, 1.71; concern about harming my baby: 38.9% vs. 31.0%, PR = 1.26, 95% CI: 1.04, 1.53) and 2011 (concern about side effects for me: 39.0% vs. 28.5%, PR = 1.37, 95% CI: 1.13, 1.65; concern about harming my baby: 38.8% vs. 31.0%, PR = 1.25, 95% CI: 1.04, 1.50). Following the 2009/2010 H1N1 pandemic, more Hispanic women cited concern about vaccination harming their baby than other women; in 2011, their concern remained elevated relative to non-Hispanic white women (63% vs. 35%; adjusted PR = 1.79, 95% CI: 1.23, 2.61). Conclusion Examining trends in reasons for non-receipt of antenatal influenza vaccination can reflect successes related to vaccine promotion and areas for improvement. By highlighting differential impacts of the 2009/2010 H1N1 pandemic, we reveal opportunities for additional research on tailoring vaccine promotion efforts to specific types of women. [ABSTRACT FROM AUTHOR]

Few reports have described how university programs have controlled COVID-19 outbreaks. Emory University established a case investigation and contact tracing program in June 2020 to identify and mitigate transmission of SARS-CoV-2 in the Emory community. In February 2021, this program identified a surge in COVID-19 cases. In this case study, we present details of outbreak investigation, construction of transmission networks to assess clustering and identify groups for targeted testing, and program quality metrics demonstrating the efficiency of case investigation and contact tracing, which helped bring the surge under control. During February 10–March 5, 2021, Emory University identified 265 COVID-19 cases confirmed by nucleic acid testing in saliva or nasopharyngeal samples. Most students with COVID-19 were undergraduates (95%) and were affiliated with Greek life organizations (70%); 41% lived on campus. Network analysis identified 1 epidemiologically linked cluster of 198 people. Nearly all students diagnosed with COVID-19 (96%) were interviewed the same day as their positive test result. Of 340 close contacts, 90% were traced and 89% were tested. The median time from contact interview to first test was 2 days (interquartile range, 0-6 days); 43% received a positive test result during their quarantine. The surge was considered under control within 17 days, after which new cases were no longer epidemiologically linked. Early detection through systematic testing protocols and rapid and near-complete contact tracing, paired with isolation and quarantine measures, helped to contain the surge. Our approach emphasizes the importance of early preparation of adequate outbreak response infrastructure and staff to implement interventions appropriately and consistently during a pandemic. [ABSTRACT FROM AUTHOR]

• The strongest predictor of selection was distance to permanently open areas. • Selection was greatest proximate to permanently open areas. • Elevation and suitable soils were the second strongest predictors of selection. Private working forest landscapes provide wildlife habitat and understanding how species interact with these landscapes is critical to identifying conservation opportunities. The gopher tortoise (Gopherus polyphemus ; hereafter, tortoise) is a species endemic to the Coastal Plain ecoregion of the southeastern United States, with private working pine (Pinus spp.) forests encompassing a substantive portion of area within the species' range. Although private working pine forests contain tortoises, uncertainty exists about how tortoises use these landscapes. Specifically, there is limited information regarding tortoise habitat associations within these landscapes relative to current forest management practices. Therefore, we used radio telemetry data from 55 adult tortoises collected over 3 years to estimate resource selection within a private working forest landscape dominated by planted loblolly pine (Pinus taeda) stands in the Upper Coastal Plain ecoregion of Georgia, USA. The strongest predictor of resource selection by tortoises was proximity to permanently open areas, specifically a utility right-of-way and areas adjacent to unpaved forest roads and, to a lesser extent, areas of higher elevation containing soils suitable for tortoises. On our study area, we identified permanently open areas as an important landscape component to adult tortoises. Although adult tortoises persist within these landscapes, more work is needed to understand tortoise recruitment in private working pine forest landscapes. [ABSTRACT FROM AUTHOR]

We used the policy sciences as an organizing framework for a series of workshops with stakeholders in Banff National Park on “Interdisciplinary problem solving for grizzly bear conservation and management.” In recent years, bear conservation efforts in this region have been hindered by acrimonious disputes about the production and use of scientific knowledge in management. The workshops introduced the policy sciences as a means of thinking more effectively about problems, and encouraged participants to use this approach to develop innovative solutions to the problems of grizzly bear conservation. Each workshop addressed different aspects of the policy sciences framework: (i) Standpoint Clarification; (ii) Problem Orientation; (iii) Social Process Mapping; and (iv) Decision-Process Mapping. In this article, we discuss the design and outcomes of the workshops and assess their effectiveness in integrating knowledge to find common ground. [ABSTRACT FROM AUTHOR]

The predicted global water shortages are so acute that water has been dubbed 'the petroleum for the next century'. Phil Chamberlain discovers that the problems of water supply and the technologies to improve it are increasingly the same for developed and developing countries. [ABSTRACT FROM AUTHOR]

Background: Households are important for SARS-CoV-2 transmission due to high intensity exposure in enclosed spaces over prolonged durations. We quantified and characterized household clustering of COVID-19 cases in Fulton County, Georgia.Methods: We used surveillance data to identify all confirmed COVID-19 cases in Fulton County. Household clustered cases were defined as cases with matching residential address. We described the proportion of COVID-19 cases that were clustered, stratified by age over time and explore trends in age of first diagnosed case within households and subsequent household cases.Results: Between June 1, 2020 and October 31, 2021, 31,449(37%) of 106,233 cases were clustered in households. Children were the most likely to be in household clusters than any other age group. Initially, children were rarely (∼ 10%) the first cases diagnosed in the household but increased to almost 1 of 3 in later periods.Discussion: One-third of COVID-19 cases in Fulton County were part of a household cluster. Increasingly children were the first diagnosed case, coinciding with temporal trends in vaccine roll-out among the elderly and the return to in-person schooling in Fall 2021. Limitations include restrictions to cases with a valid address and unit number and that the first diagnosed case may not be the infection source for the household. [ABSTRACT FROM AUTHOR]

There are 3 American black bear (Ursus americanus) populations in the state of Georgia, USA. We used multi-locus microsatellite genotypes derived from bear hair and tissue samples collected across these populations to assess levels of genetic diversity within and between populations. We used population assignment clustering to evaluate whether there has been recent immigration into the smallest of the 3 populations, the Central Georgia Bear Population. Compared with other bear populations in the United States, the North Georgia and South Georgia Bear Populations have relatively high rates of genetic diversity (Ho = 0.72 ± 0.02, A = 6.68 ± 0.32, and Ho = 0.72 ± 0.02, A = 6.82 ± 0.35, respectively). In contrast, the Central Georgia Bear Population has relatively low rates (Ho = 0.46 ± 0.03, and A = 3.96 ± 0.20). Fixation indices for pairings between Georgia bear populations indicated that the North Georgia Bear Population was more similar to the South Georgia Bear Population than either was to the Central Georgia Bear Population. Our findings suggest that the Central Georgia Bear population has experienced long-term genetic isolation and genetic drift. Of a sample of 365 bears from Central Georgia, we only detected 1 immigrant and no evidence of gene flow into the population. We recommend development and implementation of plans to encourage gene flow toward the Central Georgia Bear Population. [ABSTRACT FROM AUTHOR]

To evaluate the impact of a multi-component intervention package of maternal immunization uptake in obstetric care clinics. In a multi-level, cluster- and individually-randomized controlled trial we implemented an evidence-based intervention that targeted practice-, provider- and patient-level barriers to vaccine uptake. Obstetric practices were randomized to receive the practice and provider-level interventions or continue their normal standard of care. We enrolled pregnant women at practices in Georgia and Colorado and randomized women into patient-level intervention and control groups, resulting in four study arms. The primary outcomes were receipt of the influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccines during pregnancy. A sample size of 550 women per arm (2200 total) was planned and enrolled to compare the intervention between the four study arms. Between June 2017 and July 2018, 4907 women were screened and 2200 women were randomized, 550 to each of the four study arms. We were unable to follow-up with 108 women, for a final sample size of 2092. Sample characteristics and sample size were similar among study arms. There was no significant increase in Tdap or influenza vaccine uptake overall. Among women who had no intention of or were unsure about receiving the influenza vaccine during pregnancy, those who received just the patient-level intervention were 61% more likely to receive the influenza vaccine than those in the control arm (Relative risk: 1.61; 95% Confidence Interval: 1.18–2.21). There was no significant difference in vaccine uptake for either influenza or tetanus, diphtheria and acellular pertussis between the four arms of the study. This trial highlights the need for more targeted interventions to improve vaccine uptake. Future work should focus on clinics with low baseline vaccine uptake and the patient-level intervention should be expanded and targeted towards women with low vaccine confidence. [ABSTRACT FROM AUTHOR]

The article presents a study on the prevalence of Chlamydia trachomatis among college students in the U.S. The objective of the study is to analyze the prevalence of C. trachomatis among asymptomatic college students and to compare chlamydia positivity by chosen demographic variables. Demographical data collected on 789 students who volunteered for a urine screening of C. trachomatis and Neisseria gonorrhoeae infections at 10 colleges in Alabama, Georgia and Mississippi was analyzed. Results showed that the chlamydia prevalence among all students was 9.7%, and the median age was 20 years. It suggests that chlamydia prevalence was higher in younger college students.

• Quality improvement model shows advancement in maternal vaccination rate increases. • Tdap and influenza uptake increase in obstetrics with quality improvement model. • Successful adaption of quality improvement model around maternal vaccination. Maternal vaccination is critical for improving maternal and child health. Quality Improvement (QI) models 1 1 Abbreviation QI: Quality Improvement , such as the Centers for Disease Control and Prevention's (CDC) Assessment, Feedback, Incentives, eXchange (AFIX) 2 2 Abbreviation AFIX: Assessment, Feedback, Incentives, eXchange model, have not yet been adapted to maternal vaccinations. This study assesses the impact of AFIX-OB, an adapted version of AFIX for obstetric settings, on maternal vaccination rates. Between December 2016 and May 2018, state health departments and obstetric practices in Colorado and Georgia implemented the adapted AFIX-OB model. The model addressed unique patterns in patient encounters, practice flow, health records systems and competing clinical priorities in the obstetric setting through a menu of clearly-defined QI strategies, bi-weekly technical assistance meetings with designated immunization champions, incentives for champions/staff, and adapted tools to aid each practice during implementation. Vaccination rates were assessed by random chart reviews pre- and post-intervention. The AFIX-OB model was evaluated in eleven obstetric practices in two states as part of a multi-level intervention to increase maternal vaccination. Post AFIX-OB implementation, documented influenza vaccination rates increased from 56% at baseline to 65% (p < 0.01); and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates increased from 77% at baseline to 84% (p < 0.02) across all practices. The AFIX-OB model showed improvement in maternal vaccination rates for both influenza and Tdap vaccines. AFIX-OB may provide a useful framework for obstetric practices, as well as for other health care specialties. The focused goal should be on broader dissemination among those interested in adopting an evidence-based model for increasing vaccine uptake. [ABSTRACT FROM AUTHOR]

Infants too young to be fully vaccinated are vulnerable to potentially deadly influenza and pertussis infections. The cocooning strategy limits this risk by vaccinating those likely to interact with the infant and mother during this vulnerable time, such as close friends and family members. Distribution of accurate and accessible vaccine information through existing social networks could be an important tool in increasing vaccine confidence and coverage. We surveyed 1095 pregnant women from diverse prenatal care practices in Georgia and Colorado. These women were surveyed through a mobile app to assess vaccine intentions, attitudes, beliefs, norms, and levels of trust, and then presented brief individually-tailored educational videos about maternal and infant vaccines and the cocooning strategy. They were then given the opportunity to refer up to six contacts to enroll in the app and receive similar vaccine education. Twenty-eight percent of these women referred at least one contact, with an average of 2.67 contacts per referring woman. Most referrals (93%) were partners, parents, siblings, relatives, or close friends. Attitudinal constructs significantly associated with increased likelihood of referring contacts included: intention to receive maternal influenza vaccine, perceived safety of maternal Tdap vaccine, perceived efficacy of maternal influenza vaccine, perceived susceptibility to and severity of influenza during pregnancy, and trust in vaccine information from the Centers for Disease Control and Prevention (CDC) and academic institutions. Uncertainty about infant vaccine intentions was associated with decreased likelihood of referring contacts. Pregnant women who valued vaccination and trusted vaccine information from academic institutions were more likely to refer an educational app about vaccines than those who did not. Further research is needed to determine the potential impact of this strategy on vaccine coverage when implemented on a large scale. The survey informing this article was part of a randomized controlled trial funded by the National Institutes of Health [clinicaltrials.gov registration number NCT02898688]. [ABSTRACT FROM AUTHOR]

The development and initial assessment in a clinical setting of a theory-driven, individually tailored educational application (app), MomsTalkShots, focused on increasing uptake of maternal and infant vaccines is described. MomsTalkShots algorithmically tailored videos based on parent needs to deliver an intervention that was specifically responsive to individual vaccine attitudes, beliefs and intentions, demographics, and source credibility. MomsTalkShots was evaluated among 1103 pregnant women recruited from 23 geographically and socio-demographically diverse obstetrician-gynecologist offices in Georgia and Colorado in 2017. Self-reported information needs were assessed pre-and post-videos and participants self-reported factors related to usability and analyzed in 2018. The vast majority of women reported MomsTalkShots was helpful (95%), trustworthy (94%), interesting (97%) and clear to understand (99%), none of which varied by demographics or parity. Reported usability was slightly lower among vaccine hesitant women, yet the majority reported MomsTalkShots was helpful (91%), trustworthy (85%), interesting (97%) and clear (99%). The majority of women (72%) who did not have enough vaccine information pre-videos reported enough information post-videos. MomsTalkShots was designed to provide individually tailored vaccine information to pregnant women from a population with varied vaccine intentions, confidence and vaccine concerns. MomsTalkShots was extremely well-received among pregnant women, even among women who were initially vaccine hesitant and did not intend to vaccinate themselves and their infants according to the recommended immunization schedule. Next steps include evaluation to assess impact on vaccine uptake and expansion to adolescent and adult vaccines. [ABSTRACT FROM AUTHOR]

The Central Georgia Population (CGP) is the least abundant and most geographically isolated American black bear ( Ursus americanus) population in Georgia, USA. We used DNA-based spatially explicit capture-recapture techniques to estimate density and abundance of bears in the CGP. We sampled bear hair over 2 8-week periods during the summers of 2012 and 2013 and recorded capture histories of individual bears identified via microsatellite genotyping. Population density for females was 0.123 bears/km2 (SE = 0.018) and 0.152 bears/km2 (SE = 0.024) in 2012 and 2013, respectively. Male bear density was 0.109 bears/km2 (SE = 0.015) to 0.088 bears/km2 (SE = 0.013) during the same years. Derived estimates of abundance of female bears was 125.4 (SE = 18.3) in 2012 and 154.9 (SE = 24.3) in 2013. Male bear abundance was 111.3 (SE = 15.2) and 89.8 (SE = 12.9) for 2012 and 2013, respectively. Based on these estimates and the isolated nature of the CGP, we recommend continued monitoring of demographic parameters and a conservative approach to determining annual harvest rates. [ABSTRACT FROM AUTHOR]

Over the course of the past two decades, attrition within the US governmental public health workforce has passed concerning and become dire. The practice sector has struggled to recruit and retain new talent, despite the infusion of considerable federal investment in workforce expansion initiatives. In 2020, Emory University's Rollins School of Public Health partnered with the Georgia Department of Public Health to establish the Rollins Epidemiology Fellowship Program. Initially created to recruit and place early-career master of public health-level epidemiologists into Georgia's public health system for COVID-19 pandemic response, the two-year service-learning program has evolved into an effective and replicable model of direct academic involvement in strengthening the governmental public health workforce. Here we describe the program's structure and early results, spotlighting it for consideration by the federal government and other jurisdictions interested in directly engaging academia in efforts to revitalize the public health workforce.

The optimal interval between the first and second doses of COVID-19 mRNA vaccines has not been thoroughly evaluated. Employing a target trial emulation approach, we compared the effectiveness of different interdose intervals among >6 million mRNA vaccine recipients in Georgia, USA, from December 2020 to March 2022. We compared three protocols defined by interdose interval: recommended by the Food and Drug Administration (FDA) (17-25 days for Pfizer-BioNTech; 24-32 days for Moderna), late-but-allowable (26-42 days for Pfizer-BioNTech; 33-49 days for Moderna), and late ( ≥ 43 days for Pfizer-BioNTech; ≥50 days for Moderna). In the short-term, the risk of SARS-CoV-2 infection was lowest under the FDA-recommended protocol. Longer-term, the late-but-allowable protocol resulted in the lowest risk (risk ratio on Day 120 after the first dose administration compared to the FDA-recommended protocol: 0.83 [95% confidence interval: 0.82-0.84]). Here, we showed that delaying the second dose by 1-2 weeks may provide stronger long-term protection., (© 2024. The Author(s).)

Objective: To describe case rates, testing rates and percent positivity of COVID-19 among children aged 0-18 years by school-age grouping., Design: We abstracted data from Georgia's State Electronic Notifiable Disease Surveillance System on all 10 437 laboratory-confirmed COVID-19 cases among children aged 0-18 years during 30 March 2020 to 6 June 2021. We examined case rates, testing rates and percent positivity by school-aged groupings, namely: preschool (0-4 years), elementary school (5-10 years), middle school (11-13 years), and high school (14-18 years) and compared these data among school-aged children with those in the adult population (19 years and older)., Setting: Fulton County, Georgia., Main Outcome Measures: COVID-19 case rates, testing rates and percent positivity., Results: Over time, the proportion of paediatric cases rose substantially from 1.1% (April 2020) to 21.6% (April 2021) of all cases in the county. Age-specific case rates and test rates were consistently highest among high-school aged children. Test positivity was similar across school-age groups, with periods of higher positivity among high-school aged children., Conclusions: Low COVID-19 testing rates among children, especially early in the pandemic, likely underestimated the true burden of disease in this age group. Despite children having lower measured incidence of COVID-19, we found when broader community incidence increased, incidence also increased among all paediatric age groups. As the COVID-19 pandemic continues to evolve, it remains critical to continue learning about the incidence and transmissibility of COVID-19 in children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: On February 3, 2019, Atlanta, Georgia, hosted Super Bowl LIII, which is classified as a National Special Security Event. The festivities comprising this major sporting event brought approximately half a million people to Atlanta, which posed significant challenges to the local public health community. As the lead local agency for public health planning, preparedness, and response efforts, Fulton County Board of Health (FCBOH) needed to address multiple specific tasks based on core functional areas outlined in the Emergency Support Function (ESF) 8 (eg, bioterrorism preparedness and epidemiological surveillance)., Program: To prepare for the Super Bowl, FCBOH developed a systematic approach to ensure community-wide public health preparedness for mass gatherings. This approach came to be known as the 6 E framework, which consists of (1) engaging stakeholders, (2) examining current capabilities and identifying gaps, (3) establishing roles and responsibilities, (4) executing plans to fill gaps, (5) exercising plans, and (6) evaluating impact., Implementation: We define each step of the 6 E framework and present practical examples of how FCBOH implemented each step when preparing for the Super Bowl. Challenges that FCBOH faced and the lessons learned in the process are illustrated. The 6 E framework provides a systematic approach to community preparedness and allows local health departments to tailor the approach to serve local public health needs., Evaluation: The successful implementation of the 6 E framework allowed for stakeholders at the federal, state, and local levels (including law enforcement) to effectively coordinate an epidemiological investigation and response when 4 staff members reported gastrointestinal symptoms after eating at a feeding station., Discussion: Preparation for the Super Bowl required months of diligent cross-sectoral and cross-jurisdictional partnership building, and the 6 E framework can help other local public health jurisdictions prepare to host major mass gatherings., Competing Interests: The authors declare they have no potential conflicts of interest to disclose.

Assessing pre-exposure prophylaxis (PrEP) coverage and identifying reasons for disproportionate uptake among the varied social and cultural sub-groups of men who have sex with men (MSM) and transgender women who have sex with men (TWSM) are necessary precursors to setting attainable local PrEP. We report on findings of a cross-sectional survey among MSM/TWSM attending Gay pride events in Atlanta, Georgia, in 2018. Associations between PrEP awareness, uptake, and respondent characteristics were assessed using logistic regression. PrEP awareness did not differ by race, but current use was significantly lower among Blacks at substantial risk of HIV (p = .008). In multivariate analysis, clinician encounter in the past year was associated with awareness while age, income, drug use, sero-discordant sex, and multiple male partners were associated with current use. Among PrEP-naïve MSM/TWSM, the most common reasons for nonuse differed by race (poor knowledge of PrEP: Black-45% vs. non-Black-27%, p = .010, low perception of risk: Black-26% vs. non-Black-52%, p = .001). Key racial and socioeconomic disparities in active PrEP use and reasons for nonuse remain despite the recent increases in PrEP awareness and use among MSM/TWSM in Atlanta. Achieving overall improvement in uptake among all MSM/TWSM sub-groups will require tailoring PrEP educational messaging, optimizing communication modalities, expanding provider outreach, and identifying ways to defray costs for high-risk, underserved sub-groups in these populations.

Vaccine coverage for maternal vaccines is suboptimal; only about half of pregnant women received influenza and Tdap vaccines in 2018. We explored knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines among pregnant women. Between June 2017 and July 2018, we surveyed 2196 pregnant women recruited from geographically and socio-demographically diverse prenatal care practices in Georgia and Colorado (56% response rate). Fifty-six percent of pregnant women intended to receive both influenza and Tdap vaccines during pregnancy and 68% intended to vaccinate their baby with all recommended vaccines on time. Attitudinal constructs associated with intention to vaccinate include confidence in vaccine safety (ORs: 16-38) and efficacy (ORs: 4-19), perceived risk of vaccine-preventable diseases (ORs: 2-6), social norms (ORs: 4-10), and trust in sources of vaccine information. Women pregnant with their first child were less likely than women who had prior children to intend to vaccinate themselves and their children, more likely to be unsure about their intentions to receive both maternal and infant vaccines, and less likely to report feeling they had enough knowledge or information about vaccines and vaccine safety ( p < .01). This demonstrates an opportunity for vaccine education to increase vaccine confidence and informed decision-making, especially among first-time pregnant women.

Objective: Prenatal providers are pregnant women's most trusted sources of health information, and a provider's recommendation is a strong predictor of maternal vaccine receipt. However, other ways women prefer receiving vaccine-related information from prenatal providers, aside from face-to-face conversations, is unclear. This study explores what secondary communication methods are preferred for receiving maternal vaccine-related information., Study Design: Obstetric patients at four prenatal clinics around Atlanta, Georgia received a 27-item survey between May 5th, 2016 and June 15th, 2016. Participants were asked about sources they currently use to obtain prenatal health information and their preferences for receiving vaccine-related information from providers. Descriptive statistics were calculated and chi-square tests were used to evaluate associations between participant characteristics and outcomes., Results: Women primarily reported using the CDC website (57.7%) and pregnancy-related websites (53.0%) to obtain vaccine information. Apart from clinical conversations, educational brochures (64.9%) and e-mails (54.7%) were the preferred methods of receiving vaccine information from providers, followed by their provider's practice website (42.1%). Communication preferences and interest in maternal immunization varied by race/ethnicity, age and education; white women were twice as likely to want information on a provider's practice website compared to African-American women (OR = 2.06; 95% CI: 1.31, 3.25)., Conclusions: Pregnant women use the Internet for information about vaccines, but they still value input from their providers. While e-mails and brochures were the preferred secondary modes of receiving information, a provider's existing practice website offers a potential communications medium that capitalizes on women's information seeking behaviors and preferences while limiting burden on providers.

Objective: We sought to examine the effectiveness of persuasive communication interventions on influenza vaccination uptake among black/African American pregnant women in Atlanta, Georgia., Methods: We recruited black/African American pregnant women ages 18 to 50 y from Atlanta, GA to participate in a prospective, randomized controlled trial of influenza immunization messaging conducted from January to April 2013. Eligible participants were randomized to 3 study arms. We conducted follow-up questionnaires on influenza immunization at 30-days post-partum with all groups. Chi-square and t tests evaluated group differences, and outcome intention-to-treat assessment utilized log-binomial regression models., Results: Of the 106 enrolled, 95 women completed the study (90% retention), of which 31 were randomly assigned to affective messaging intervention ("Pregnant Pause" video), 30 to cognitive messaging intervention ("Vaccines for a Healthy Pregnancy" video), and 34 to a comparison condition (receipt of the Influenza Vaccine Information Statement). The three groups were balanced on baseline demographic characteristics and reported health behaviors. At baseline, most women (63%, n = 60) reported no receipt of seasonal influenza immunization during the previous 5 y. They expressed a low likelihood (2.1 ± 2.8 on 0-10 scale) of obtaining influenza immunization during their current pregnancy. At 30-days postpartum follow-up, influenza immunization was low among all participants (7-13%) demonstrating no effect after a single exposure to either affective messaging (RR = 1.10; 95% CI: 0.30-4.01) or cognitive messaging interventions (RR = 0.57; 95% CI: 0.11-2.88). Women cited various reasons for not obtaining maternal influenza immunizations. These included concern about vaccine harm (47%, n = 40), low perceived influenza infection risk (31%, n = 26), and a history of immunization nonreceipt (24%, n = 20)., Conclusion: The findings reflect the limitations associated with a single exposure to varying maternal influenza immunization message approaches on vaccine behavior. For this population, repeated influenza immunization exposures may be warranted with alterations in message format, content, and relevance for coverage improvement.