Explore the vast range of titles available.

Brief Report: Zika Virus Infection and Fetal Brain Abnormalities In this case report, the association between Zika virus infection and teratogenicity is strengthened, with evidence that the latency period between ZIKV infection of the fetal brain and the detection of microcephaly and intracranial calcifications on ultrasonography may be prolonged. Zika virus (ZIKV), a mosquito-borne flavivirus and member of the Flaviviridae family, was originally isolated from a sentinel primate in Uganda in 1947. 1 ZIKV was associated with mild febrile disease and maculopapular rash in tropical Africa and some areas of Southeast Asia. Since 2007, ZIKV has caused several outbreaks outside its former distribution area in islands of the Pacific: in 2007 on Yap island in Micronesia, in 2013 and 2014 in French Polynesia, and in 2015 in South America, where ZIKV had not been identified previously. 2 – 5 There are separate African and Asian lineages of the virus, 6 and the latter . . .

INTRODUCTION:Opioids are commonly prescribed to patients with chronic liver disease, but little is known regarding medication prescribing patterns of hepatologists. Opioid use increased until national guidelines limited opioid prescriptions in early 2016. We aimed to describe rates of opioid and nonopioid analgesics to Medicare beneficiaries by hepatologists from 2013 to 2017 and identify demographic characteristics associated with higher prescribing.METHODS:Prescription data from 2013 to 2017 by 761 hepatologists identified in the Centers for Medicare and Medicaid Services Part D Public Use File were analyzed. Annual prescription volumes were compared for providers with >10 annual prescriptions of a given drug type. Provider characteristics associated with opioid prescriptions were identified through multivariate logistic regression analyses.RESULTS:The proportion of hepatologists prescribing >10 annual opioid prescriptions decreased from 29% to 20.6%. Median annual opioid prescriptions per hepatologist significantly decreased from 24 to 20. Tramadol remained the most prescribed analgesic. Nonopioid analgesic prescription volume did not increase significantly. Provider characteristics associated with increased opioid prescriptions included male sex, practice location in the South and Midwest (vs West), more years in practice, and a greater proportion of beneficiaries who are white or with low-income subsidy claims. Characteristics associated with fewer prescriptions included non-university-based practice, having a greater proportion of female beneficiaries, and later prescription year.DISCUSSION:Hepatologists are prescribing less opioids. However, the prevalence of tramadol use and the lack of increase in nonopioid analgesic use highlights the need for advancing the science and training of pain management in chronic liver disease and targeted implementation of nonopioid treatment programs.

Limited information is available on influenza virus sequence drift between transmission events. In countries with high HIV burdens, like South Africa, the direct and indirect effect of HIV on influenza sequence drift between transmission events may be of public health concern. To this end, we measured hemagglutinin sequence diversity between influenza transmission events using data and specimens from a study investigating household transmission dynamics of seasonal influenza viruses in 2 peri-urban communities in South Africa during the 2013 influenza season. Thirty index cases and 107 of 110 eligible household contacts were enrolled into the study, 47% (14/30) demonstrating intra-household laboratory-confirmed influenza transmission. In this study 35 partial hemagglutinin gene sequences were obtained by Sanger sequencing from 11 index cases (sampled at enrolment only) and 16 secondary cases (8 cases sampled at 1 and 8 cases sampled at 2 time-points). Viral sequence identities confirmed matched influenza transmission pairs within the 11 households with corresponding sequenced index and secondary cases. Phylogenetic analysis revealed 10 different influenza viral lineages in the 14 households. Influenza A(H1N1)pdm09 strains were shown to be genetically distinct between the 2 communities (from distinct geographic regions), which was not observed for the influenza A(H3N2) strains. Intra-host/intra-household influenza A(H3N2) sequence drift was identified in 2 households. The first was a synonymous mutation between the index case and a household contact, and the second a non-synonymous mutation between 2 serial samples taken at days 0 and 4 post enrolment from an HIV-infected secondary case. Limited inter-household sequence diversity was observed as highlighted by sharing of the same influenza strain between different households within each community. The limited intra-household sequence drift is in line with previous studies also using Sanger sequencing, corroborating the presence of strict selective bottlenecks that limit sequence variance. We were not able to directly ascertain the effect of HIV on influenza sequence drift between transmission events.

Background: At the start of the COVID-19 pandemic, the DC Department of Health (DC Health) mandated new case reporting for early outbreak detection: (1) weekly healthcare personnel (HCP) absenteeism line lists indicating staff absent for confirmed or suspected SARS-CoV-2, (2) daily line lists of all SARS-CoV-2–positive inpatients, and (3) hospital contact tracing. Between March 27, 2020, and December 31, 2020, DC Health detected 36 confirmed and 14 suspected hospital outbreaks, of which only 18% (8 confirmed and 1 suspect) were known to the affected hospital. DC Health learned which outbreaks warranted early or aggressive intervention by tracking outbreak characteristics across its jurisdiction. This allowed prioritization of during surges when it was difficult for DC Health and hospital staff to investigate every outbreak. Methods: Potential outbreaks in short-stay and inpatient rehabilitation hospitals were flagged after identifying SARS-CoV-2 hospital-onset (HO) inpatients or staff clusters on line lists. Variables of interest in line lists included specimen collection and hospital admission dates, units or departments, and patient contact. Facility contact tracing by infection preventionists further verified epidemiological links among cases. Outbreak details were systematically tracked in a locally developed REDCap database and were analyzed if they had an initial case, outbreak start date, or an investigation start date in 2020. Frequency procedures, SQL statements, and date calculations were computed using SAS Enterprise Guide version 8.3 software. Results: Confirmed outbreaks had an average of 6.92 (range, 0–32) HCP and 2.58 (range, 0–22) patient cases, with 69% being confirmed-HO cases and 31% probable HO. Moreover, 53% of confirmed outbreaks occurred in the following departments: cardiac, behavioral health, intensive care, and environmental services (EVS)/facilities. All of these departments had recurrent outbreaks. Behavioral health, medical and cardiac units had the highest number of patient cases. On average, confirmed outbreak investigations lasted 24.6 days, with outbreaks prolonged in the ICU (40.25 days) and the medical unit (37.67 days). Top triggers for investigations ultimately classified as confirmed outbreaks were (1) positive symptomatic HCP, (2) confirmed-HO cases, and (3) exposures from positive HCP. Conclusions: The dynamic nature of COVID-19 created challenges in detecting and responding to hospital outbreaks. Developing a low-resource outbreak tracking system helped identify outbreak types and triggers that warranted early or aggressive interventions. Understanding the characteristics of hospital outbreaks was critical for maximizing infection control resources during surges of infectious disease outbreaks, such as COVID-19. Hospitals or local health departments could adapt this system to meet their needs. Funding: None Disclosures: None

The occurrence of cases of COVID-19 reported by child care facilities among children, teachers, and staff members is correlated with the level of community spread (1,2). To describe characteristics of COVID-19 cases at child care facilities and facility adherence to guidance and recommendations, the District of Columbia (DC) Department of Health (DC Health) and CDC reviewed COVID-19 case reports associated with child care facilities submitted to DC Health and publicly available data from the DC Office of the State Superintendent of Education (OSSE) during July 1-December 31, 2020. Among 469 licensed child care facilities, 112 (23.9%) submitted 269 reports documenting 316 laboratory-confirmed cases and three additional cases identified through DC Health's contact tracers. Outbreaks associated with child care facilities, defined as two or more laboratory-confirmed and epidemiologically linked cases at a facility within a 14-day period (3), occurred in 27 (5.8%) facilities and accounted for nearly one half (156; 48.9%) of total cases. Among the 319 total cases, 180 (56.4%) were among teachers or staff members. The majority (56.4%) of facilities reported cases to DC Health on the same day that they were notified of a positive test result for SARS-CoV-2, the virus that causes COVID-19, by staff members or parents. Facilities were at increased risk for an outbreak if they had been operating for <3 years, if symptomatic persons sought testing ≥3 days after symptom onset, or if persons with asymptomatic COVID-19 were at the facility. The number of outbreaks associated with child care facilities was limited. Continued implementation and maintenance of multiple prevention strategies, including vaccination, masking, physical distancing, cohorting, screening, and reporting, are important to reduce transmission of SARS-CoV-2 in child care facilities and to facilitate a timely public health response to prevent outbreaks. .

Nodding syndrome (NS) is a seizure disorder of unknown etiology, predominately affecting children aged 3-18 years in three sub-Saharan countries (Uganda, South Sudan, and Tanzania), with the primary feature of episodic head nodding. These episodes are thought to be one manifestation of a syndrome that includes neurologic deterioration, cognitive impairment, and additional seizure types. NS investigations have focused on clinical features, progression, and etiology; however, none have provided a population-based prevalence assessment using a standardized case definition. In March 2013, CDC and the Ugandan Ministry of Health (MOH) conducted a single-stage cluster survey to perform the first systematic assessment of prevalence of NS in Uganda using a new consensus case definition, which was modified during the course of the investigation. Based on the modified definition, the estimated number of probable NS cases in children aged 5-18 years in three northern Uganda districts was 1,687 (95% confidence interval [CI] = 1,463-1,912), for a prevalence of 6.8 (CI = 5.9-7.7) probable NS cases per 1,000 children aged 5-18 years in the three districts. These findings can guide the MOH to understand and provide the health-care resources necessary to address NS in northern Uganda, and provide a basis for future studies of NS in Uganda and in other areas affected by NS.

Herbal medicines are used by patients with IBD despite limited evidence. We present a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating treatment with herbal medicines in active ulcerative colitis (UC). A search query designed by a library informationist was used to identify potential articles for inclusion. Articles were screened and data were extracted by at least two investigators. Outcomes of interest included clinical response, clinical remission, endoscopic response, endoscopic remission, and safety. We identified 28 RCTs for 18 herbs. In pooled analyses, when compared with placebo, clinical response rates were significantly higher for Indigo naturalis (IN) (RR 3.70, 95% CI 1.97–6.95), but not for Curcuma longa (CL) (RR 1.60, 95% CI 0.99–2.58) or Andrographis paniculata (AP) (RR 0.95, 95% CI 0.71–1.26). There was a significantly higher rate of clinical remission for CL (RR 2.58, 95% CI 1.18–5.63), but not for AP (RR 1.31, 95% CI 0.86–2.01). Higher rates of endoscopic response (RR 1.56, 95% CI 1.08–2.26) and remission (RR 19.37, 95% CI 2.71–138.42) were significant for CL. CL has evidence supporting its use as an adjuvant therapy in active UC. Research with larger scale and well-designed RCTs, manufacturing regulations, and education are needed.

Background and Aims The impact of dietary sugar intake on the risk of developing inflammatory bowel disease is unclear, with inconsistent findings across studies. The aim of this systematic review and meta‐analysis was to clarify how sugar consumption contributes to the risk of developing inflammatory bowel disease (IBD) using the most recently available data. Methods A library informationist retrieved relevant articles from PubMed, EMBASE, CINAHL, Cochrane Central, Web of Science, and Scopus. Two independent reviewers screened the s and full texts, yielding 45 studies for inclusion. Meta‐analyses estimated odd ratios using random effect models. Results 11 prospective and 34 retrospective studies reported data on sugar intake and IBD risk. Pooled analysis showed that added sugar intake was associated with increased risk of Crohn's disease (OR 1.66; 95% Cl 1.21–2.29; n = 523,730; 14 studies) and ulcerative colitis (OR 1.59; 95% CI 1.25–2.02; n = 787,228; 18 studies). Similarly, soda/sweetened beverage intake was associated with increased risk of Crohn's disease (OR 1.58; 95% CI 1.18–2.12; n = 328,716; 12 studies) and ulcerative colitis (OR 1.72; 95% CI 1.23–2.391; n = 328,642; 13 studies). Conclusions Sugar and soda/sweetened beverage intake were associated with an increased risk of developing both Crohn's disease and ulcerative colitis. Although additional prospective investigation is warranted, current data suggest that reduction of sugar consumption might help reduce the risk of inflammatory bowel disease.

Background: In June 2019, the Maryland Department of Health (MDH) was notified of a hospitalized patient with Candida auris bloodstream infection. The MDH initiated a contact investigation to identify additional patients with C. auris colonization. Many of the contacts had been discharged home from the hospital and were therefore not available for screening. Healthcare facilities in Maryland, Virginia, and Washington, DC, submit patient data to a regional health information exchange (HIE) called the Chesapeake Regional Information System for our Patients (CRISP). CRISP includes a notification system that alerts providers when flagged patients have healthcare encounters. We aimed to use this system to identify discharged C. auris contacts on their next inpatient encounter to rapidly screen them and to detect new cases. Methods: C. auris contacts were defined as patients located on an inpatient unit on the same day, receiving wound care from the same team, or having a procedure in the same operating room on the same day as the index patient or any patients subsequently identified as having C. auris infection or colonization detected either during the normal course of clinical care or through screening. Contacts who remained hospitalized were screened during inpatient point prevalence surveys (PPSs). Contacts discharged to postacute-care facilities were screened by facility staff. Contacts who had been discharged home were flagged in CRISP, and MDH staff received CRISP encounter alerts when these patients were readmitted. MDH staff then contacted the admitting facilities to recommend screening for C. auris . Axilla and groin swabs were collected and tested by rt-PCR at the Mid-Atlantic Regional Antibiotic Resistance Laboratory Network laboratory. Results: As of October 8, 2019, 4,017 contacts were identified. Among these, 936 (23%) contacts at 56 healthcare facilities (33 acute-care hospitals and 23 postacute-care facilities) were screened for C. auris, and 10 patients with C. auris colonization were identified (1.1% of contacts who underwent C. auris screening). Of these, 6 (60%) were identified through CRISP notification and 4 (40%) were identified by PPSs conducted in acute-care hospitals. Conclusions: In this ongoing C. auris outbreak, a large proportion of colonized patients was identified using an electronic encounter notification system within a regional HIE. This approach was effective for identifying opportunities to screen contacts at their next healthcare encounter and can augment other means of case detection, like PPSs. HIEs should incorporate mechanisms to facilitate contact tracing for public health investigations. Funding: None Disclosures: None