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[This corrects the article DOI: 10.1371/journal.pone.0304918.].

A multistate outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) occurred in 2019. Because of EVALI's novelty and severity, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) prospectively assessed sequelae among NYC residents who received an EVALI diagnosis in 2019. Using existing NYC EVALI surveillance data, DOHMH attempted contact with all living residents who received an EVALI diagnosis in 2019 and conducted 3 waves of telephone interviews during April 2020-March 2021. Interview questions were adapted from the Centers for Disease Control and Prevention's EVALI case report form and validated surveys. Baseline differences between respondents and nonrespondents were assessed with Chi-square and Fisher's exact tests; clinical and behavioral characteristics and open-ended responses were summarized. In 2019, 53 NYC residents received an EVALI diagnosis; 33 (67%), 14 (29%), and 18 (37%) of 49 living residents participated in the first, second, and third interviews, respectively. Interviews occurred after outpatient diagnosis (6%) or hospital discharge (94%), at a median of 8, 11, and 17 months for each wave. Respondents (N = 33) and nonrespondents (N = 16) did not differ by sex, age, hospitalization status or length. Respondents were mostly male (70%), had a median age of 23 years (range: 16-63 years), and all reported using vaping or e-cigarette products (vaping) with tetrahydrocannabinol (88%), nicotine (49%), or cannabidiol (9%) before diagnosis. Respiratory (first and second interviews) and gastrointestinal (third interviews) symptoms were most commonly reported. Sixteen respondents (49%) reported any new diagnosis during follow-up. Fifteen to 29% of respondents reported vaping at each interview; 58%-93% reported recent non-vaped cannabinoid use. NYC residents with EVALI reported symptoms throughout the follow-up period, and approximately half reported newly diagnosed health conditions. Further studies are needed to understand EVALI's relationship with symptoms and health conditions.

University settings have demonstrated potential for coronavirus disease (COVID-19) outbreaks; they combine congregate living, substantial social activity, and a young population predisposed to mild illness. Using genomic and epidemiologic data, we describe a COVID-19 outbreak at the University of Wisconsin-Madison, Madison, Wisconsin, USA. During August-October 2020, a total of 3,485 students, including 856/6,162 students living in dormitories, tested positive. Case counts began rising during move-in week, August 25-31, 2020, then rose rapidly during September 1-11, 2020. The university initiated multiple prevention efforts, including quarantining 2 dormitories; a subsequent decline in cases was observed. Genomic surveillance of cases from Dane County, in which the university is located, did not find evidence of transmission from a large cluster of cases in the 2 quarantined dorms during the outbreak. Coordinated implementation of prevention measures can reduce COVID-19 spread in university settings and may limit spillover to the surrounding community.

Youth aged 15–24 years comprise 48% of new HIV infections and 15% of persons living with HIV in Kisumu County, Kenya. We assessed factors associated with HIV infection among youth participating in the Community Health Initiative (CHI) implemented in an urban informal settlement in 2018. Predictors of HIV infection were assessed by multivariable logistic regression. CHI engaged 4,441 youth through community health campaigns and home-based HIV testing. HIV prevalence was 3.5% overall and 7.1% among young women aged 20–24. There were 24 youth newly identified as HIV-positive out of 157 total HIV-positive youth. HIV-positive status was positively associated with being female (aOR = 2.46; 95% CI 1.57, 3.84) and aged 20–24 (aOR = 2.40; 95% CI 1.52, 3.79), and inversely associated with secondary school education or higher (aOR = 0.27; 95% CI 0.16, 0.44). Our findings highlight the need for HIV prevention programs specially tailored for youth to further reduce new HIV infections in this priority population.

International research studies often leverage the knowledge and lived experience of in-country investigators to develop data collection tools and analyze the resulting data, but not that of local research staff. Recognizing this missed opportunity, the Maneno Yetu study implemented a novel collaborative, cross-cultural approach that leveraged our team members’ knowledge of the study communities. Our U.S.- and Kenya-based research team jointly participated in interview guide development and data analysis for focus group discussions exploring sexual and reproductive health behaviors of Kenyan adolescents. Our Kenya-based team members drew from their own adolescence growing up in similar environments to develop an interview guide that resonated with our study population and conducted the data analysis, with training and mentoring by U.S.-based members. We created a team structure and research environment that promoted egalitarianism, inclusiveness, and collectiveness within the rigor of a National Institutes of Health study. Our approach fostered a supportive working environment, created family-like dynamics, empowered equal partnerships, and amplified investment in the success of the study. Engaging both U.S.- and Kenya-based members in all study phases and integrating capacity building as a study goal helped develop our team’s qualitative research skills. The collaborative team approach strengthened the validity of findings and provided professional development opportunities. Future studies can benefit greatly by leveraging the valuable contributions of all team members, irrespective of educational degree or position title. Given our team’s overwhelmingly positive experience, we encourage other investigators to integrate this collaborative, cross-cultural approach into their research programs.

To limit introduction of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), the United States restricted travel from China on February 2, 2020, and from Europe on March 13. To determine whether local transmission of SARS-CoV-2 could be detected, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) conducted deidentified sentinel surveillance at six NYC hospital emergency departments (EDs) during March 1-20. On March 8, while testing availability for SARS-CoV-2 was still limited, DOHMH announced sustained community transmission of SARS-CoV-2 (1). At this time, twenty-six NYC residents had confirmed COVID-19, and ED visits for influenza-like illness* increased, despite decreased influenza virus circulation. The following week, on March 15, when only seven of the 56 (13%) patients with known exposure histories had exposure outside of NYC, the level of community SARS-CoV-2 transmission status was elevated from sustained community transmission to widespread community transmission (2). Through sentinel surveillance during March 1-20, DOHMH collected 544 specimens from patients with influenza-like symptoms (ILS) who had negative test results for influenza and, in some instances, other respiratory pathogens. All 544 specimens were tested for SARS-CoV-2 at CDC; 36 (6.6%) tested positive. Using genetic sequencing, CDC determined that the sequences of most SARS-CoV-2-positive specimens resembled those circulating in Europe, suggesting probable introductions of SARS-CoV-2 from Europe, from other U.S. locations, and local introductions from within New York. These findings demonstrate that partnering with health care facilities and developing the systems needed for rapid implementation of sentinel surveillance, coupled with capacity for genetic sequencing before an outbreak, can help inform timely containment and mitigation strategies.

BackgroundA multistate outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) occurred in 2019. Because of EVALI's novelty and severity, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) prospectively assessed sequelae among NYC residents who received an EVALI diagnosis in 2019.MethodsUsing existing NYC EVALI surveillance data, DOHMH attempted contact with all living residents who received an EVALI diagnosis in 2019 and conducted 3 waves of telephone interviews during April 2020-March 2021. Interview questions were adapted from the Centers for Disease Control and Prevention's EVALI case report form and validated surveys. Baseline differences between respondents and nonrespondents were assessed with Chi-square and Fisher's exact tests; clinical and behavioral characteristics and open-ended responses were summarized.ResultsIn 2019, 53 NYC residents received an EVALI diagnosis; 33 (67%), 14 (29%), and 18 (37%) of 49 living residents participated in the first, second, and third interviews, respectively. Interviews occurred after outpatient diagnosis (6%) or hospital discharge (94%), at a median of 8, 11, and 17 months for each wave. Respondents (N = 33) and nonrespondents (N = 16) did not differ by sex, age, hospitalization status or length. Respondents were mostly male (70%), had a median age of 23 years (range: 16-63 years), and all reported using vaping or e-cigarette products (vaping) with tetrahydrocannabinol (88%), nicotine (49%), or cannabidiol (9%) before diagnosis. Respiratory (first and second interviews) and gastrointestinal (third interviews) symptoms were most commonly reported. Sixteen respondents (49%) reported any new diagnosis during follow-up. Fifteen to 29% of respondents reported vaping at each interview; 58%-93% reported recent non-vaped cannabinoid use.ConclusionNYC residents with EVALI reported symptoms throughout the follow-up period, and approximately half reported newly diagnosed health conditions. Further studies are needed to understand EVALI's relationship with symptoms and health conditions.

Background COVID-19 mortality studies have primarily focused on persons aged ≥ 65 years; less is known about decedents aged <65 years. Methods We conducted a case-control study among NYC residents aged 21–64 years hospitalized with COVID-19 diagnosed March 13–April 9, 2020, to determine risk factors for death. Case-patients (n=343) were hospitalized decedents with COVID-19 and control-patients (n=686) were discharged from hospitalization with COVID-19 and matched 2:1 to case-patients on age and residential neighborhood. Conditional logistic regression models were adjusted for patient sex, insurance status, and marital status. Matched adjusted odds ratios (aORs) were calculated for selected underlying conditions, combinations of conditions, and race/ethnic group. Results Median age of both case-patients and control-patients was 56 years (range: 23–64 years). Having ≥ 1 selected underlying condition increased odds of death 4.45-fold (95% CI: 2.33–8.49). Patients with diabetes; morbid obesity; heart, kidney, or lung disease; cancer; neurologic/neurodevelopmental conditions; mental health conditions; or HIV had significantly increased odds of death. Compared with having neither condition, having both diabetes and obesity or diabetes and heart disease was associated with approximately threefold odds of death. Five select underlying conditions were more prevalent among non-Hispanic Black control-patients than among control-patients of other races/ethnicities. Conclusions and Relevance Selected underlying conditions were risk factors for death, and most prevalent among racial/ethnic minorities. Social services; health care resources, including vaccination; and tailored public health messaging are important for COVID-19 prevention. Strengthening these strategies for racial/ethnic minority groups could minimize COVID-19 racial/ethnic disparities.

As of April 19, 2021, 21.6 million COVID-19 cases had been reported among U.S. adults, most of whom had mild or moderate disease that did not require hospitalization (1). Health care needs in the months after COVID-19 diagnosis among nonhospitalized adults have not been well studied. To better understand longer-term health care utilization and clinical characteristics of nonhospitalized adults after COVID-19 diagnosis, CDC and Kaiser Permanente Georgia (KPGA) analyzed electronic health record (EHR) data from health care visits in the 28-180 days after a diagnosis of COVID-19 at an integrated health care system. Among 3,171 nonhospitalized adults who had COVID-19, 69% had one or more outpatient visits during the follow-up period of 28-180-days. Compared with patients without an outpatient visit, a higher percentage of those who did have an outpatient visit were aged ≥50 years, were women, were non-Hispanic Black, and had underlying health conditions. Among adults with outpatient visits, 68% had a visit for a new primary diagnosis, and 38% had a new specialist visit. Active COVID-19 diagnoses* (10%) and symptoms potentially related to COVID-19 (3%-7%) were among the top 20 new visit diagnoses; rates of visits for these diagnoses declined from 2-24 visits per 10,000 person-days 28-59 days after COVID-19 diagnosis to 1-4 visits per 10,000 person-days 120-180 days after diagnosis. The presence of diagnoses of COVID-19 and related symptoms in the 28-180 days following acute illness suggests that some nonhospitalized adults, including those with asymptomatic or mild acute illness, likely have continued health care needs months after diagnosis. Clinicians and health systems should be aware of post-COVID conditions among patients who are not initially hospitalized for acute COVID-19 disease.