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Background: Improving HIV detection and prevention remains a critical public health initiative that requires policy-based solutions. This study sought to compare HIV detection/prevention behaviors before and after healthcare reform in Massachusetts, USA, among heterosexually active persons — the group with the highest reported number of undiagnosed HIV cases. The current study sought to (1) characterize differences in insurance coverage and HIV detection/prevention behaviors between cycles 1 (2006) to 5 (2019); (2) evaluate socio-demographic disparities in insurance coverage accounting for cycle; and (3) evaluate associations between health insurance coverage and HIV detection/prevention behaviors accounting for cycle and socio-demographics. Methods: This is a secondary analysis of the National HIV Behavioral Surveillance (NHBS) project: Boston HET cycle (i.e., made up of heterosexually active persons living in the Boston area) data. Descriptive, bivariate (e.g., chi-square), and multiple logistic and negative binomial loglink regression analyses were conducted. Results: In chi-square analyses with post hoc Bonferroni tests, the proportion of participants with current health insurance significantly increased from cycle 1 (77%) to cycle 2 (95%), p <.001. In the regression models that controlled for NHBS cycle, 1-year change in age (adjusted odds ratio [aOR] = 1.03, 95% confidence interval [CI] = 1.02, 1.05), female gender (aOR = 3.41, 95% CI = 2.48, 4.69), and change in education category (aOR = 1.19, 95% CI = 1.02, 1.39) were associated with a higher likelihood of having health insurance. In regression models that controlled for cycle, age, gender, and education, participants with health insurance were more likely than those without insurance to report seeing a medical provider in the past year (aOR = 3.49, 95% CI = 2.32, 4.66), ever having an HIV test (aOR = 1.52, 95% CI = 0.35, 2.69) and more frequent HIV testing in the past 2 years (incidence rate ratio [IRR] = 1.44, 95% = 1.14, 1.82). Participants with health insurance did not differ from those without insurance in number of vaginal condomless sex partners (IRR = 1.16, 95% CI = 0.95, 1.41) but did report more condomless anal sex partners in the past year (IRR = 1.97, 95% CI = 1.46, 2.65). Conclusions: This study demonstrates how health insurance coverage is positively associated with HIV detection and prevention relevant to both US and international efforts to end the HIV epidemic. [ABSTRACT FROM AUTHOR]

Introduction: Injection drug use is the most frequently reported risk behavior among new cases of hepatitis C virus infection, and recent reports of increases in infection are of great concern in many communities. This study assessed the prevalence and trends in injection drug use among U.S. high school students.Methods: Data were from CDC's Youth Risk Behavior Surveillance System, which collects information on health risk behaviors at the national, state, and large urban school district levels. Analyses were conducted in 2014.Results: In 2013, 1.7% of high school students nationwide had ever injected any illegal drug. Nationwide, ever injecting any illegal drug did not change significantly from 1995 to 2013, except among black non-Hispanic students. For this subgroup, both a significant linear increase from 1995 to 2013 and a significant quadratic trend were observed, with injection drug use increasing from 1995 to 2009 and decreasing from 2009 to 2013. Significant linear increases in injection drug use occurred in five states (Arkansas, Hawaii, Maine, Maryland, and New York) and six large urban school districts (Baltimore, Memphis, Miami-Dade County, New York City, Philadelphia, and Seattle). Significant linear decreases occurred in three states (Massachusetts, South Dakota, and West Virginia). Both a significant linear increase and quadratic trend were observed in Maine; quadratic trends were observed in Tennessee, Utah, and Palm Beach County, Florida.Conclusions: In some geographic areas and population groups, an increasing or high frequency of injection drug use was found among high school students, who should be targeted for prevention. [ABSTRACT FROM AUTHOR]

Background The clinical course of hepatitis A virus (HAV) infection is more severe with increased age. In the United States, surveillance data reported to CDC since 2011 indicate increases in both the absolute number of cases and the mean age of cases. Total antibody to HAV (anti-HAV) is a marker of immunity. Methods We analyzed National Health and Nutrition Examination Survey (NHANES) data for anti-HAV from respondents aged ≥2 years collected from 2007 to 2012 and compared with data collected 10 years earlier (1999–2006). For US-born adults aged ≥20 years, we estimated age-adjusted anti-HAV prevalence by demographic and other characteristics, evaluated factors associated with anti-HAV positivity and examined anti-HAV prevalence by decade of birth. Results The prevalence of anti-HAV among adults aged ≥20 years was 24.2% (95% CI 22.5–25.9) during 2007–2012, a significant decline from 29.5% (95% CI 28.0–31.1) during 1999–2006. Prevalence of anti-HAV was consistently lower in 2007–2012 compared to 1999–2006 by all characteristics examined. In 2007–2012, the lowest age-specific prevalence was among adults aged 30–49 years (16.1–17.6%). Factors significantly associated with anti-HAV positivity among adults were older age, Mexican American ethnicity, living below poverty, less education, and not having insurance. By decade of birth, the prevalence of anti-HAV was slightly lower in 2009–2012 than in 1999–2002, except among persons born from 1980 to 1989. Conclusions NHANES data document very low prevalence of hepatitis A immunity among U.S. adults aged 30–49 years; waning of anti-HAV over time may be minimal. Improving vaccination coverage among susceptible adults should be considered. [ABSTRACT FROM AUTHOR]

Background. An estimated 20 000 new hepatitis B virus (HBV) infections occur each year in the United States. We describe the results of enhanced surveillance for acute hepatitis B at 7 federally funded sites over a 6-year period. Methods. Health departments in Colorado, Connecticut, Minnesota, Oregon, Tennessee, 34 counties in New York state, and New York City were supported to conduct enhanced, population-based surveillance for acute HBV from 2006 through 2011. Demographic and risk factor data were collected on symptomatic cases using a standardized form. Serum samples from a subset of cases were also obtained for molecular analysis. Results. In the 6-year period, 2220 acute hepatitis B cases were reported from the 7 sites. For all sites combined, the incidence rate of HBV infection declined by 19%, but in Tennessee incidence increased by 90%, mainly among persons of white race/ethnicity and those aged 40-49 years. Of all reported cases, 66.1% were male, 57.1% were white, 58.4% were aged 30-49 years, and 60.1% were born in the United States. The most common risk factor identified was any drug use, notably in Tennessee; healthcare exposure was also frequently reported. The most common genotype for all reported cases was HBV genotype A (82%). Conclusions. Despite an overall decline in HBV infection, attributable to successful vaccination programs, a rise in incident HBV infection related to drug use is an increasing concern in some localities. [ABSTRACT FROM AUTHOR]

Background: In recent years, few US adults have had exposure and resultant immunity to hepatitis A virus (HAV). Further, persons with liver disease have an increased risk of adverse consequences if they are infected with HAV. Methods: This study used 1999-2011 National Notifiable Diseases Surveillance System and Multiple Cause of Death data to assess trends in the incidence of HAV infection, HAV-related hospitalization, and HAV-related mortality. Results: During 1999-2011, the incidence of HAV infection declined from 6.0 cases/100 000 to 0.4 cases/100 000. Similar declines were seen by sex and age, but persons aged ≥80 years had the highest incidence of HAV infection in 2011 (0.8 cases/100 000). HAV-related hospitalizations increased from 7.3% in 1999 to 24.5% in 2011. The mean age of hospitalized cases increased from 36.0 years in 1999 to 45.1 years in 2011. While HAV-related mortality declined, the mean age at death among decedents with HAV infection increased from 48.0 years in 1999 to 76.2 years in 2011. The median age range of decedents who had HAV infection and a liver-related condition was 51.0 to 68.0 years. Conclusions: Although vaccine-preventable, HAV-related hospitalizations increased greatly, mostly among adults, and liver-related conditions were frequently reported among HAV-infected individuals who died. Public health efforts should focus on the need to assess protection from hepatitis A among adults, including those with liver disease. [ABSTRACT FROM AUTHOR]

Objectives. Because only a fraction of patients with acute viral hepatitis A, B, and C are reported through national surveillance to the Centers for Disease Control and Prevention, we estimated the true numbers. Methods. We applied a simple probabilistic model to estimate the fraction of patients with acute hepatitis A, hepatitis B, and hepatitis C who would have been symptomatic, would have sought health care tests, and would have been reported to health officials in 2011. Results. For hepatitis A, the frequencies of symptoms (85%), care seeking (88%), and reporting (69%) yielded an estimate of 2730 infections (2.0 infections per reported case). For hepatitis B, the frequencies of symptoms (39%), care seeking (88%), and reporting (45%) indicated 18 730 infections (6.5 infections per reported case). For hepatitis C, the frequency of symptoms among injection drug users (13%) and those infected otherwise (48%), proportion seeking care (88%), and percentage reported (53%) indicated 17 100 infections (12.3 infections per reported case). Conclusions. These adjustment factors will allow state and local health authorities to estimate acute hepatitis infections locally and plan prevention activities accordingly. [ABSTRACT FROM AUTHOR]

In 2010, three-fourths of 18 473 viral hepatitis–related deaths occurred among persons aged 45–64 years. Decedents who had a hepatitis B- or C-related death died 22–23 years younger than decedents who did not have a hepatitis B- or C-related death.Background. Previous research indicates that the mortality burden from viral hepatitis is growing, particularly among middle-aged persons. To monitor progress toward prevention goals, it is important to continue to document characteristics and comortalities of these deaths. This study sought to examine demographic characteristics and the most frequent causes of death among decedents with a viral hepatitis–related death.Methods. A cross-sectional study was performed on approximately 2.4 million death records from 2010. We calculated mortality rates for decedents with and without hepatitis A, B, and C virus (HAV, HBV, and HCV) and relative risks for the most frequently cited conditions in decedents with and without HBV and HCV.Results. In 2010, there were 18 473 (0.7%) deaths with HAV, HBV, and HCV listed among causes of death, disproportionately in those aged 45–64 years. Among the 10 frequent causes of death, decedents listing HBV or HCV died, on average, 22–23 years earlier than decedents not listing these infections. HBV- and HCV-infected decedents aged 45–64 years had an increased risk of having the following conditions reported than decedents without these infections: cancer of liver and intrahepatic bile duct; fibrosis, cirrhosis, and other liver diseases; alcohol-related liver disease; gastrointestinal hemorrhage; human immunodeficiency infection; acute and unspecified renal failure; and septicemia (HCV only).Conclusions. Decedents with other causes of death that include HBV or HCV died 22–23 years earlier than decedents not listing these infections. These data suggest and support the need for prevention, early identification, and treatment of HBV and HCV. [ABSTRACT FROM PUBLISHER]

Background and Overview. Changes in the science of hepatitis C virus (HCV) infection and transmission in a private dental practice provide an opportunity to update dental health care providers about this pathogen. The authors' aims in this review were to create awareness of health care-associated transmission of hepatitis C and provide an update on the changes in testing and treatment. The authors include data from population-based epidemiologic surveys, clinical practice guidelines, surveillance reports and practice protocols. Results. In the United States, the elevated prevalence of chronic HCV infection among baby boomers-people born during the period from 1945 through 1965-led the Centers for Disease Control and Prevention to release new national screening guidelines. The authors summarize information about the natural history and epidemiology of hepatitis C and describe the new guidelines and novel treatment options. In addition, the authors provide an overview of how outbreaks of health care-associated HCV are detected and prevented. Practical Implications. Because dental health care professionals likely will treat people with current infection, education in the current science of HCV infection is useful. [ABSTRACT FROM AUTHOR]

Objectives. Centers for Disease Control and Prevention has recommended a 1-time HCV test for persons born from 1945 through 1965 to supplement current risk-based screening. We examined indications for testing by birth cohort (before 1945, 1945-1965, and after 1965) among persons with past or current HCV. Methods. Cases had positive HCV laboratory markers reported by 4 surveillance sites (Colorado, Connecticut, Minnesota, and New York) to health departments from 2004 to 2010. Health department staff abstracted demographics and indications for testing from cases' medical records and compiled this information into a surveillance database. Results. Of 110 223 cases of past or current HCV infection reported during 2004-2010, 74 578 (68%) were among persons born during 1945-1965. Testing indications were abstracted for 45 034 (41%) cases; of these, 29 544 (66%) identified at least 1 Centers for Disease Control and Prevention-recommended risk factor as a testing indication. Overall, 74% of reported cases were born from 1945 to 1965 or had an injection drug use history. Conclusions. These data support augmenting the current HCV risk-based screening recommendations by screening adults born from 1945 to 1965. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infection is a serious public health problem. New infections continue to occur, and morbidity and mortality are increasing among an estimated 2.7-3.9 million persons in the United States living with HCV infection. Most persons are unaware of their infection status. Existing CDC guidelines for laboratory testing and reporting of antibody to HCV do not distinguish between past infection that has resolved and current infection that requires care and evaluation for treatment. To identify current infection, a test for HCV RNA is needed. Methods: Surveillance data reported to CDC from eight U.S. sites during 2005-2011 were analyzed to determine the proportion of persons newly reported on the basis of a positive test result for HCV infection. Persons reported with a positive result from an HCV antibody test only were compared with persons reported with a positive result for HCV RNA and examined by birth cohort (1945-1965 compared with all other years), surveillance site, and number of reported deaths. Annual rates of persons newly reported with HCV infection in 2011 also were calculated for each site. Results: Of 217,755 persons newly reported, 107,209 (49.2%) were HCV antibody positive only, and 110,546 (50.8%) were reported with a positive HCV RNA result that confirmed current HCV infection. In both groups, persons were most likely to have been born during 1945-1965 (58.5% of those who were HCV antibody positive only; 67.2% of those who were HCV RNA positive). Among all persons newly reported for whom death data were available, 6,734 (3.4%) were known to have died; deaths were most likely among persons aged 50-59 years. In 2011, across all sites, the annual rate of persons newly reported with HCV infection (positive HCV antibody only and HCV RNA positive) was 84.7 per 100,000 population. Conclusions: Hepatitis C is a commonly reported disease predominantly affecting persons born during 1945-1965, with deaths more frequent among persons of relatively young age. The lack of an HCV RNA test for approximately one half of persons newly reported suggests that testing and reporting must improve to detect all persons with current infection. Implications for Public Health: In an era of continued HCV transmission and expanding options for curative antiviral therapies, surveillance that identifies current HCV infection can help assess the need for services and link persons with infection to appropriate care and treatment. [ABSTRACT FROM AUTHOR]

Objective. We compared the quality of data reported to the Centers for Disease Control and Prevention (CDC) from sites that received funding for acute viral hepatitis surveillance through CDC's Emerging Infections Program (EIP) with sites that have electronic infrastructure to collect data but do not receive funding from CDC to support viral hepatitis surveillance. Methods. Descriptive analysis was conducted on acute hepatitis A, B, and C cases reported from EIP sites and National Electronic Disease Surveillance System (NEDSS)-based states (NBS) sites from 2005 to 2007. Data were compared for (1) completeness of demographic and risk behavior/exposure information; (2) adherence to CDC/Council of State and Territorial Epidemiologists (CSTE) case definition for confirmed cases of acute hepatitis A, B, and C; and (3) timeliness of reporting to the health department. Results. Data reported for sex and age were at least 98% complete for both EIP and NBS sites and race/ethnicity was more complete for EIP sites. For acute hepatitis A, B, and C, case reports from EIP sites were more likely than those from NBS sites to include a "yes" response to at least one risk behavior/exposure variable and were more likely to meet the CDC/CSTE case definition. EIP sites received case reports in a more timely fashion than did NBS sites. The case definition for acute hepatitis C proved problematic for both EIP and NBS sites. Conclusions. Data from the EIP sites were more complete and reported in a more timely way to health departments than data from the NBS sites. Funding for follow-up activities is essential to providing surveillance data of higher quality for decision-making and public health response. [ABSTRACT FROM AUTHOR]

Background: The increasing health burden and mortality from hepatitis B virus (HBV) and hepatitis C virus (HCV) in the United States are underappreciated. Objective: To examine mortality from HBV; HCV; and, for comparison, HIV. Design: Analysis of U.S. multiple-cause mortality data from 1999 to 2007 from the National Center for Health Statistics. Setting: All U.S. states and the District of Columbia. Participants: Approximately 22 million decedents. Measurements: Age-adjusted mortality rates from HBV, HCV, and HIV. Logistic regression analyses of 2007 data generated 4 independent models per outcome (HCV- or HBV-related deaths) that each included 1 of 4 comorbid conditions and all sociodemographic characteristics. Results: Between 1999 and 2007, recorded deaths from HBV increased significantly to 15 106, whereas deaths from HIV declined to 12 734 by 2007. Factors associated with HCV-related deaths included chronic liver disease, HBV co-infection, alcohol-related conditions, minority status, and HIV co-infection. Factors that increased odds of HBV-related death included chronic liver disease, HCV co-infection, Asian or Pacific Islander descent, HIV coinfection, and alcohol-related conditions. Most deaths from HBV and HCV occurred in middle-aged persons. Limitation: A person other than the primary physician of the decedent frequently completed the death certificate, and HCV and HBV often were not detected and thus not reported as causes of death. Conclusion: By 2007, HCV had superseded HIV as a cause of death in the United States, and deaths from HCV and HBV disproportionately occurred in middle-aged persons. To achieve decreases in mortality similar to those seen with HIV requires new policy initiatives to detect patients with chronic hepatitis and link them to care and treatment. Primary Funding Source: Centers for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]

Objectives. We described seroprevalence of antibody to hepatitis A virus (anti- HAV) in the United States during 1999-2006 and compared it with seroprevalence before the availability of vaccine. Methods. We analyzed data from the 1988-1994 and 1999-2006 National Health and Nutrition Examination Survey (NHANES) to obtain estimates of anti- HAV seroprevalence for the U.S. household population. We grouped region of residence based on the 1999 Advisory Committee on Immunization Practices recommendations into 17 states with any recommendation (vaccinating) and 33 states without any recommendation (non-vaccinating). Results. During 1999-2006, the overall seroprevalence of anti-HAV was 34.9% (95% confidence interval [CI] 33.1, 36.7). During 1999-2006, U.S.-born children living in vaccinating states (33.8%, 95% CI 26.2, 42.2) had a higher seroprevalence than children in non-vaccinating states (11.0%, 95% CI 9.4, 12.8; p<0.001). Seroprevalence among children increased from 8.0% (95% CI 6.3, 10.1) during 1988-1994 to 20.2% (95% CI 16.0, 24.8) during 1999-2006 (p<0.001). For U.S.-born children aged 6-19 years, the strongest factor associated with seroprevalence was residence in vaccinating states. Among U.S.-born adults aged >19 years, the overall age-adjusted seroprevalence of. anti-HAV was 29.9% (95% CI 28.3, 31.5) during 1999-2006, which was not significantly different from the seroprevalence during 1988-1994 (32.2%, 95% CI 30.1, 34.4). Conclusions. Increases in seroprevalence among children in vaccinating states suggest a positive effect of the 1999 vaccination recommendations. [ABSTRACT FROM AUTHOR]

The article investigates the evolving epidemiology of Hepatitis A in six U.S. sites conducting population-based surveillance in the Emerging Infections Program from 2005-2007. The worldwide incidence of hepatitis A virus (HAV) infection each year is estimated at 1.4 million cases. The U.S. study reported 1,156 HAV cases within the period where the combined population under surveillance was 29.8 million while the overall annual incidence was 1.3 per 100,000 population. International travel is said to be the predominant risk factor for the transmission.

Surveillance for hepatitis C virus infection in 6 US sites identified 20,285 newly reported cases in 12 months (report rate 69 cases/100,000 population, range 25-108/100,000). Staff reviewed 4 laboratory reports per new case. Local surveillance data can document the effects of disease, support linkage to care, and help prevent secondary transmission. [ABSTRACT FROM AUTHOR]

Thirty-two outpatient hemodialysis providers in the United States voluntarily reported 3699 adverse events to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) during 2006. These providers were previously enrolled in the Dialysis Surveillance Network. The pooled mean rates of hospitalization among patients with arteriovenous fistulas, grafts, permanent and temporary central venous catheters were 7.7, 9.2, 15.7, and 34.7 per 100 patient-months, respectively. For bloodstream infection the pooled mean rates were 0.5, 0.9, 4.2, and 27.1 per 100 patient-months in these groups. Among the 599 isolates reported, 461 (77%) represented access-associated blood stream infections in patients with central lines, and 138 (23%) were in patients with fistulas or grafts. The microorganisms most frequently identified were common skin contaminants (e.g., coagulase-negative staphylococci). In 2007, enrollment in NHSN opened to all providers of outpatient hemodialysis. Specific information is available at . [ABSTRACT FROM AUTHOR]

This article presents the results of a study on community-associated methicillin-resistant Staphylococcus aureus (MRSA) which has become the most frequent cause of skin and soft tissue infections presenting in emergency rooms throughout the U.S. This study looked to describe the incidence and distribution of MRSA disease in 9 U.S. communities and to estimate the burden for the U.S. in 2005. The authors found 8987 cases of MRSA in the targeted areas during 18 months, most of which were health care-associated. The standard incident rate was 31.8 per 100,000 people but were higher in the elderly, African Americans and males. The average mortality rate in 2005 was 6.3 per 100,000 people.

Objective. The purpose of this study was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals. Methods. No single source of nationally representative data on HAIs is currently available. The authors used a multi-step approach and three data sources. The main source of data was the National Nosocomial Infections Surveillance (NNIS) system, data from 1990-2002, conducted by the Centers for Disease Control and Prevention. Data from the National Hospital Discharge Survey (for 2002) and the American Hospital Association Survey (for 2000) were used to supplement NNIS data. The percentage of patients with an HAI whose death was determined to be caused or associated with the HAI from NNIS data was used to estimate the number of deaths. Results. In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, was approximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among newborns in well-baby nurseries, 417,946 among adults and children in ICUs, and 1,266,851 among adults and children outside of ICUs. The estimated deaths associated with HAIs in U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites. Conclusion. HAIs in hospitals are a significant cause of morbidity and mortality in the United States. The method described for estimating the number of HAIs makes the best use of existing data at the national level. [ABSTRACT FROM AUTHOR]

Context: Little is known about the extent of extraimmunization, ie, vaccine doses given in excess of the recommended schedule, and whether it should be a public health concern.Objectives: To determine the extent and cost of extraimmunization in children and to identify its associated factors.Design, Setting, and Participants: United States 1997 National Immunization Survey, in which telephone interviews were conducted with parents of 32742 19- to 35-month-old children and vaccination histories were collected from health care providers for 22806 of these children (overall response rate, 68.5%). Estimates were weighted to represent the full sample.Main Outcome Measures: Frequency of extraimmunization compared by vaccine type as well as with adequate immunization; factors associated with extraimmunization; and vaccine and visit costs associated with extraimmunization.Results: Frequency of extraimmunization was less than 5% for each vaccine considered except poliovirus (14.1%). Overall, 21% of children were extraimmunized for at least 1 vaccine vs 31% underimmunized for at least 1 vaccine. In a multivariate model, the strongest contributors to extraimmunization were having more than 1 immunization provider (odds ratio [OR], 2.8; 95% confidence interval [CI], 2.4-3.2) and having multiple types of providers (eg, private and public health department; OR, 2.0; 95% CI, 1.6-2.4). Children seen only in public health department clinics were significantly less likely to be extraimmunized (OR, 0.3; 95% CI, 0.2-0.3). Annual costs associated with extraimmunization for this cohort of children were estimated conservatively at $26.5 million.Conclusions: These data indicate that extraimmunization can be costly. The challenge is to reduce extraimmunization without interfering with more important efforts to combat underimmunization. Improvements in immunization record keeping and sharing practices may help reduce extraimmunization. [ABSTRACT FROM AUTHOR]

The objective of this study was to verify the mode of exposure to the human immunodeficiency virus (HIV) among cases who obtained acquired immunodeficiency syndrome (AIDS) through heterosexual contact and to determine the proportion of cases initially reported with no risk but whose exposure may have been heterosexual. Adults aged ≥13 years with AIDS, diagnosed from 1992 through 1995 with heterosexual risk or no risk at six US study sites (Alabama, California, Florida, New Jersey, New York City, and Texas), were eligible. Heterosexual risk was validated in 82% (1,610/1,952) of the heterosexual cases. Men were more likely than women to have a risk other than heterosexual (24% vs. 13%, χ2 p < 0.01). An HIV risk was identified for 351 (55%) of those cases with no risk, and men were more likely than women to remain without risk (48% vs. 38%, χ2 p = 0.02). Of the 415 men with no risk, 215 (52%) were reclassified: 94 (44%) were men who had sex with men, 61 (28%) were injection drug users, 48 (22%) had a heterosexual risk, and 12 (6%) had other exposures. Of the 219 women with no risk, 136 (62%) were reclassified: 82 (60%) had a heterosexual risk, 47 (35%) were injection drug users, and 6 (4%) had infection associated with transfusion. In conclusion, most cases reported with heterosexually acquired AIDS had Valid heterosexual risk exposures. Am J Epidemiol 1999;149:75–84. [ABSTRACT FROM PUBLISHER]

The proportion of Staphylococcus aureus isolates that were methicillin resistant (MRSA) increased from 35.9% in 1992 to 64.4% in 2003 for hospitals in the National Nosocomial Infections Surveillance system. During the same period, there was a decrease in resistance rates for several non-β-lactam drugs among the MRSA isolates. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the epidemiology and clarity of Hepatitis A in the U.S.

The impact of hepatitis C virus (HCV) infection on health and medical care in the United States is a major problem for infectious disease physicians. Although the incidence of HCV infection has declined markedly in the past 2 decades, chronic infection in 3 million or more residents now accounts for more disease and death in the United States than does human immunodeficiency virus (HIV)/AIDS. Current trends in the epidemiology of HCV infection include an apparent increase in young, often suburban heroin injection drug users who initiate use with oral prescription opioid drugs; infections in nonhospital healthcare (clinic) settings; and sexual transmission among HIV-infected persons. Infectious disease physicians will increasingly have the responsibility of diagnosing and treating HCV patients. An understanding of how these patients were infected is important for determining whom to screen and treat. [ABSTRACT FROM AUTHOR]

Introduction: Excessive alcohol use exacerbates morbidity and mortality among hepatitis C virus (HCV)-infected people. The purpose of this study was to describe self-reported patterns of alcohol use and examine the association with HCV infection and other sociodemographic and health-related factors.Methods: Data from 20,042 participants in the 2003-2010 National Health and Nutrition Examination Survey were analyzed in 2014. Estimates were derived for self-reported demographic characteristics, HCV-RNA (indicative of current HCV infection) status, and alcohol use at four levels: lifetime abstainers, former drinkers, non-excessive current drinkers, and excessive current drinkers.Results: Former drinkers and excessive current drinkers had a higher prevalence of HCV infection (2.2% and 1.5%, respectively) than never or non-excessive current drinkers (0.4% and 0.9%, respectively). HCV-infected adults were estimated to ever drink five or more drinks/day almost every day at some time during their lifetime about 3.3 times more often (43.8% vs 13.7%, p<0.001) than those who were never infected with HCV. Controlling for age, sex, race/ethnicity, education, and having a usual source of health care, HCV infection was significantly associated with excessive current drinking (adjusted prevalence ratio, 1.3; 95% CI=1.1, 1.6) and former drinking (adjusted prevalence ratio, 1.3; 95% CI=1.1, 1.6).Conclusions: Chronic HCV infection is associated with both former and excessive current drinking. Public health HCV strategies should implement interventions with emphasis on alcohol abuse, which negatively impacts disease progression for HCV-infected individuals. [ABSTRACT FROM AUTHOR]

: BackgroundThe 2002 Recommended Childhood Immunization Schedule clarified the definition of an invalid dose of vaccine as any dose administered ≥5 days before the minimum age or interval had elapsed. Any invalid dose of vaccine should be repeated.: ObjectiveDetermine the proportion of U.S. children who received an invalid dose of vaccine, evaluate the impact on vaccination coverage levels if invalid doses were not counted, and determine the vaccine purchase cost if at least one invalid dose is repeated.: MethodsProvider-reported vaccination histories of children aged 19 to 35 months sampled by the 2000 National Immunization Survey were evaluated. Analyses were performed in 2002 after the 2002 Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule was released. Any vaccine dose administered ≥5 days before the recommended minimum age or interval was classified as invalid. Change in vaccination coverage was determined by subtracting estimated valid-dose coverage (based on number of valid doses received) from the estimated up-to-date coverage (based on number of doses received regardless of age or spacing).: ResultsOverall, 10.5% (±0.6%) of children had received at least one invalid dose of vaccine. Of the invalid doses, 51% were hepatitis B, 100% of which were the third dose; 19% were diphtheria–tetanus–pertussis (DTP/DTaP), 92% of which were the fourth dose; 12% were measles-containing vaccine (MCV); 15% were varicella vaccine; and 4% were polio vaccine, 96% of which were the first dose. Excluding invalid doses resulted in a small change in vaccination coverage: 2.2% for DTP/DTaP, 0.7% for polio, 6.5% for hepatitis B, 1.4% for MCV, and 1.7% for varicella. The vaccine purchase cost to repeat at least one invalid dose ranged from approximately $10 million (public-purchased) to approximately $18 million (private-purchased).: ConclusionsNationally about 595,000 of children aged 19 to 35 months, born between February 1997 and May 1999, received at least one invalid dose of vaccine. The cost of revaccinating these children is substantial and may have a negative impact on parents, physicians, and vaccine purchasers. Educating immunization providers regarding proper immunization timing should be conducted to reduce the administration of invalid doses of vaccines. [Copyright &y& Elsevier]

Men who have sex with men and identify as persons of color (MSM of color) are significantly impacted by HIV in the United States. The COVID-19 pandemic may have disproportionately exacerbated HIV-related disparities among MSM of color by affecting sexual networking behaviors and disrupting access to sexual health care. The current study explored the impact of COVID-19 on sexual networking and HIV/sexually transmitted infection (STI) prevention behaviors among MSM of color in Boston, MA. Eighteen semi-structured interviews were conducted via the 2020-2021 Boston sample of the National HIV Behavioral Surveillance (NHBS) project. Eligible participants were at least 18 years old, identified as a man or non-binary person assigned male at birth and as a person of color, and endorsed ever having sex with men. Interviews were coded using inductive and deductive approaches, and themes were extracted using thematic analysis. When participants were asked about the impact of COVID-19 on sexual networking and HIV/STI prevention, the following themes emerged: (1) differing interpretations of COVID-19 public health guidance, (2) behavior change to meet social and sexual needs, (3) limited or changed access to HIV/STI prevention services; and (4) avoidance of healthcare appointments. Overall, the pandemic affected sexual networking and HIV/STI prevention behaviors among MSM of color. Though changes in sexual networking varied, most participants decreased in-person networking, increased dating app use, and prioritized longer-term relationships. Despite loosening of restrictions, these impacts may persist and should inform the adaptation of sexual networking guidance and interventions to mitigate HIV-related disparities in communities of color., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Since 2014, multiple outbreaks of human immunodeficiency virus (HIV) among people who inject drugs have occurred across the United States along with hepatitis C virus (HCV), skin and soft tissue infections (SSTIs), and infective endocarditis (IE), creating a converging public health crisis., Methods: We analyzed the temporal patterns of infectious disease and overdose using a hierarchical Bayesian distributed lag logistic regression model examining the probability that a given geographic area experienced at least 1 HIV case in a given month as a function of the counts/rates of overdose, HCV, SSTI, and IE and associated medical procedures at different lagged time periods., Results: Current-month HIV is associated with increasing HCV cases, abscess incision and drainage, and SSTI cases, in distinct temporal patterns. For example, 1 additional HCV case occurring 5 and 7 months previously is associated with a 4% increase in the odds of observing at least 1 current-month HIV case in a given locale (odds ratios, 1.04 [90% credible interval {CrI}: 1.01-1.10] and 1.04 [90% CrI: 1.00-1.09]). No such associations were observed for echocardiograms, IE, or overdose., Conclusions: Lagged associations in other infections preceding rises in current-month HIV counts cannot be described as predictive of HIV outbreaks but may point toward newly discovered epidemics of injection drug use and associated clinical sequalae, prompting clinicians to screen patients more carefully for substance use disorder and associated infections., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: In the United States, the number of overdose deaths related to opioids in combination with stimulants has increased; however, the Northeast has typically been less impacted by stimulant overdose. Injection drug use (IDU) results in high mortality from overdose and infectious disease and there are racial disparities observed in overdose death rates. We examined trends in stimulant and opioid IDU, including trends stratified by race, using 5 waves of cross-sectional state surveillance data., Methods: Data came from the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance system Boston, Massachusetts site, which includes 5 waves of data (2005-2018) among adults in the Boston metropolitan area reporting IDU (N = 2550). Outcome measures were type of substance injected in the past 12 months (heroin, prescription opioids, "speedball," cocaine, crack, and/or methamphetamine)., Results: Participants were 70% male, 58% non-Hispanic White, and injected a mean of 3 different drugs in the past 12 months. From 2015 to 2018, there was a more than 2-fold increase in injection of methamphetamine (15% vs 38%, P < 0.001), a pattern which held across racial groups. Combination heroin and methamphetamine injection increased from 2015 (15%) to 2018 (35%, P < 0.001). Multiple drug injection (injecting >1 drug) increased significantly across years compared with single drug injection ( P = 0.03)., Conclusions: Findings suggest that increased use of methamphetamine and opioids extends to Boston. There is an urgent need for enhanced screening of methamphetamine use among those using opioids and increased access and payor coverage of efficacious treatments for stimulant and opioid use disorders (eg, contingency management and medication treatment for opioid use disorder)., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 American Society of Addiction Medicine.)

Background: The authors aimed to measure population-based preventable emergency department (ED) visits related to infectious oral conditions (IOCs) in Massachusetts and to examine the associated sociodemographic factors to support prevention efforts., Methods: A statewide retrospective analysis of ED visits related to IOCs in Massachusetts from 2014 through 2018 was conducted using a Center for Health Information and Analysis database. The authors described patients' characteristics, dental diagnoses frequencies, emergency severity, lengths of stay, associated treatment, and costs. Multilevel logistic regression was used to assess factors associated with IOC visits., Results: IOC visits in 2014 through 2018 were 1.2% (149,777) of the total ED visits, with an estimated cost of $159.7 million. There was an annual decline in the prevalence of IOC visits from 2014 through 2018. After adjusting for sociodemographic factors, odds of IOC were higher among males (adjusted odd ratio [AOR], 1.26; 95% CI, 1.24 to 1.27), non-Hispanic Blacks compared with non-Hispanic Whites (AOR, 1.03; 95% CI, 1.02 to 1.06), people residing in dental health care professional shortage areas (AOR, 1.06; 95% CI, 1.04 to 1.07), public insurance beneficiaries (AOR, 1.90; 95% CI, 1.87 to 1.93), or uninsured (AOR, 2.60; 95% CI, 2.54 to 2.66) compared with privately insured., Conclusions: There was an annual decline in the prevalence of IOC visits from 2014 through 2018. Higher odds of IOC visits were associated with young adults, Black patients, uninsured people, public insurance beneficiaries, and people who reside in dental health care professional shortage areas., Practical Implications: The authors provided statewide data to support proposed policies to improve oral health care in Massachusetts. IOCs are mostly preventable, but well-coordinated care between medicine and dentistry is integral for prevention., (Copyright © 2021 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: With increasing use electronic health records (EHR) in the USA, we looked at the predictive values of the International Classification of Diseases, 9th revision (ICD-9) coding system for surveillance of chronic hepatitis B virus (HBV) infection., Materials and Methods: The chronic HBV cohort from the Chronic Hepatitis Cohort Study was created based on electronic health records (EHR) of adult patients who accessed services from 2006 to 2008 from four healthcare systems in the USA. Using the gold standard of abstractor review to confirm HBV cases, we calculated the sensitivity, specificity, positive and negative predictive values using one qualifying ICD-9 code versus using two qualifying ICD-9 codes separated by 6 months or greater., Results: Of 1 652 055 adult patients, 2202 (0.1%) were confirmed as having chronic HBV. Use of one ICD-9 code had a sensitivity of 83.9%, positive predictive value of 61.0%, and specificity and negative predictive values greater than 99%. Use of two hepatitis B-specific ICD-9 codes resulted in a sensitivity of 58.4% and a positive predictive value of 89.9%., Discussion: Use of one or two hepatitis B ICD-9 codes can identify cases with chronic HBV infection with varying sensitivity and positive predictive values., Conclusions: As the USA increases the use of EHR, surveillance using ICD-9 codes may be reliable to determine the burden of chronic HBV infection and would be useful to improve reporting by state and local health departments.

We used data reported from US hospitals to the National Nosocomial Infection Surveillance System of the Centers for Disease Control and Prevention for 3 specific infections: Staphylococcus aureus bloodstream infections, Pseudomonas aeruginosa pneumonias, and Escherichia coli urinary tract infections. We evaluated the proportion of infections with antimicrobial-resistant isolates and the relative risk of death associated with the resistant pathogen in the period 2000-2004, compared with the period 1990-1994. The proportion of antimicrobial-resistant infections increased, but there was no change in the relative risk of death between the 2 periods.

Background and Overview: In 2005 in the United States, an estimated 94,370 new, invasive infections and 18,650 deaths were associated with methicillin-resistant Staphylococcus aureus (MRSA); most of these infections were in people with exposures in health care settings. MRSA also has emerged as a community-based pathogen, causing primarily skin infections that are not life-threatening, but occasionally causing more severe and invasive infections. The authors describe the history of MRSA; identify populations at greatest risk of experiencing MRSA colonization and infection; compare characteristics of MRSA infections occurring in health care and community settings; and summarize strategies, based on U.S. Centers for Disease Control and Prevention recommendations and the literature, to prevent transmission of MRSA in dental offices., Conclusions and Clinical Implications: Standard infection control precautions should be enforced strictly in all ambulatory care settings, including dental offices, to prevent facility-based transmission of MRSA and other infectious agents.

Objective: To describe methods to assess the practical impact of risk adjustment for central line-days on the interpretation of central line-associated bloodstream infection (BSI) rates, because collecting these data is often burdensome., Methods: We analyzed data from 247 hospitals that reported to the adult and pediatric intensive care unit component of the National Nosocomial Infections Surveillance System from 1995 through 2003. For each unit each year, we calculated the percentile error as the absolute value of the difference between the percentile based on a risk-adjusted or more-sophisticated measure (eg, the central line-day rate) and the percentile based on a crude or less-sophisticated measure (eg, the patient-day rate). Using rate per central line-day as the "gold standard," we calculated performance characteristics (eg, sensitivity and predictive values) of rate per patient-day for finding central line-associated BSI rates higher or lower than the mean. Greater impact of risk adjustment is indicated by higher values for percentile error and lower values for performance characteristics., Results: The median percentile error was +/-7 (i.e., the percentile based on central line-days could be 7% higher or lower than the percentile based on patient-days). This error was less than 10 percentile points for 62% of the unit-years, was between 10 and 19 percentile points for 22% of the unit-years, and was 20 percentile points or more for 15% of the unit-years. Use of the rate based on patient-days had a sensitivity of 76% and a positive predictive value of 61% for detecting a significantly high or low central line-associated BSI rate., Conclusions: We found that risk adjustment for central line-days has an important impact on the calculated central line-associated BSI percentile for some units. Similar methods can be used to evaluate the impact of other risk adjustment methods. Our results support current recommendations to use central line-days for surveillance of central line-associated BSI when comparisons are made among facilities.

To determine frequency of methicillin-resistant Staphylococcus aureus infections caused by strains typically associated with community-acquired infections (USA300) among persons with healthcare-related risk factors (HRFs), we evaluated surveillance data. Of patients with HRFs, 18%-28% had a "community-associated" strain, primarily USA300; of patients without HRFs, 26% had a "healthcare-associated" strain, typically USA100.

Background: The Advisory Committee on Immunization Practices and the Healthcare Infection Control Practices Advisory Committee recommended that hospitals establish on-site, daily assessments of health care workers vaccinated with smallpox vaccine. The Hospital Smallpox Vaccination Monitoring System (HSVMS) was 1 component of the smallpox vaccination plan to monitor adverse events on-site in hospitals. This report presents findings from February to August 2003., Methods: All US institutions participating in the smallpox vaccination program were eligible to enroll in and use HSVMS through the Internet-based Centers for Disease Control Secure Data Network., Results: Of the 730 enrolled vaccinees, 341 (47%) were nurses; 122 (17%) physicians; 75 (10%) laboratory, patient care, radiology, or other technicians; 39 (5%) administrators; 22 (3%) housekeepers; 21 (3%) physical or respiratory therapists; 20 (3%) infection control professionals; 19 (3%) safety or security staff; and 17 (2%) epidemiologists; and 54 (7%) were workers in other job categories. Most (86%) vaccinees had been previously vaccinated. Postvaccination signs and symptoms were frequent: itching (75.2%), pain at the vaccination site (31.6%), swollen or tender lymph nodes (26.4%), fatigue (26.2%), and headache (20.8%). Symptoms were highest during the first week after vaccination; symptoms were more frequently reported among vaccinees without previous vaccination. Adherence to recommended vaccination site care was reported in 2732 of 3091 (88.4%) follow-up visits among workers with patient contact. Of the 4379 days workers planned to work, during 31 (0.7 per 100) days, workers performed restricted activities, and, in 60 (1.4 per 100) days, workers were absent., Conclusions: Findings from HSVMS indicate that adherence to post-smallpox vaccination site care was high and that the number of days of work affected was low.

Unlabelled: Monitoring infections and antibiotic resistance patterns in dialysis populations is an important component of efforts to improve patient safety and quality of health care. The objective of this report is to update findings from the Dialysis Surveillance Network and describe the soon-to-be-available National Healthcare Safety Network., Methods: Volunteer dialysis centers in the DSN submitted reports of hospitalizations, outpatient intravenous antimicrobial starts, and positive blood cultures. From these reports, an online system calculated rates of important adverse events. For this report, we summarize adverse-event data submitted to the DSN from September 1999 through March 2005., Results: There were 53,804 events in the 321,519 patient-months during the period of analysis. The rate of hospitalization was 13 per 100 patient-months; the rate of outpatient IV vancomycin starts was 3 per 100 patient-months. The rate of vascular access infection was 3.1 per 100 patient-months and varied from 0.6 for fistulas to 10. 1.for temporary catheters. Of the 8,359 blood isolates reported, 77% (6,427) were primary bacteremias (5,275 were catheter-associated, 1,152 were fistula- or graft-associated), 19% (1,587) were secondary bacteremias, and 4% (345) were contaminants., Conclusions: Infection-related adverse events remain lowest among patients with vascular access in the form of fistulas and grafts. In the future, adverse events in dialysis will be monitored in the NHSN. The new, Web-based, NHSN surveillance system allows centers to monitor their rates and compare with other outpatient dialysis centers. In 2006, CDC plans to open enrollment for outpatient dialysis centers not already in the DSN.