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In April 2020, during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Europe, a cluster of children with hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome was reported in England* (1). The patients' signs and symptoms were temporally associated with COVID-19 but presumed to have developed 2-4 weeks after acute COVID-19; all children had serologic evidence of infection with SARS-CoV-2, the virus that causes COVID-19 (1). The clinical signs and symptoms present in this first cluster included fever, rash, conjunctivitis, peripheral edema, gastrointestinal symptoms, shock, and elevated markers of inflammation and cardiac damage (1). On May 14, 2020, CDC published an online Health Advisory that summarized the manifestations of reported multisystem inflammatory syndrome in children (MIS-C), outlined a case definition, and asked clinicians to report suspected U.S. cases to local and state health departments. As of July 29, a total of 570 U.S. MIS-C patients who met the case definition had been reported to CDC. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results. The remaining 367 (64.4%) of MIS-C patients had manifestations that appeared to overlap with acute COVID-19 (2-4), had a less severe clinical course, or had features of Kawasaki disease. Median duration of hospitalization was 6 days; 364 patients (63.9%) required care in an intensive care unit (ICU), and 10 patients (1.8%) died. As the COVID-19 pandemic continues to expand in many jurisdictions, clinicians should be aware of the signs and symptoms of MIS-C and report suspected cases to their state or local health departments; analysis of reported cases can enhance understanding of MIS-C and improve characterization of the illness for early detection and treatment.

A 6-year-old male neutered boxer mix canine was presented for a one-month history of dyschezia, hematochezia, and constipation. Colonoscopy and endoscopic biopsies revealed non-specific lymphoplasmacytic, eosinophilic colitis. Despite pursuing various therapies over a 3.5-month clinical course (including hypoallergenic diet, antibiotics, prokinetics, laxatives, and anti-inflammatory glucocorticoids), the patient’s condition did not improve. Two and a half months after initial presentation, the patient developed circumferential proctitis with multiple draining tracts and obstipation. Humane euthanasia and postmortem examination were elected. Gross and histological findings revealed locally extensive pyogranulomatous coloproctitis with many intralesional PAS-positive, GMS-negative 30–40 μm in diameter, hyaline, pauciseptate, irregularly branching fungal hyphae, hyphal bodies or chlamydospores and 25–45 μm in diameter thick-walled zygospores. Fungal culture of fluid from the draining tracts was performed, and DNA sequence analysis of the ITS and partial LSU of the nuclear ribosomal RNA genes were used to identify and confirm a novel species, Basidiobolus arizonensis . Basidiobolus spp. are saprobes in the order Basidiobolales and most commonly cause granulomatous infections of the skin, respiratory tract, and gastrointestinal tract in veterinary species and humans. To the authors’ knowledge, this is the first report of novel Basidiobolus arizonensis causing localized coloproctitis in a dog.

Critical thermal limits, commonly quantified as CTmax (maximum) or CTmin (minimum), are core metrics in the thermal biology of aquatic ectotherms. CTmax, in particular, has recently surged in popularity due to its various applications, including understanding and predicting the responses of animals to climate warming. Despite its growing popularity, there is a limited literature aimed at establishing best practices for designing, running and reporting CTmax experiments. This lack of standardisation and insufficiently detailed reporting in the literature creates challenges when designing CTmax studies or comparing results across studies. Here, we provide a comprehensive, practical guide for designing and conducting experiments to measure critical thermal limits, with an emphasis on CTmax. Our recommendations cover 12 topic areas including apparatus design, masking (blinding), warming rates, end points, replication and reporting. We include diagrams and photos for designing and building critical thermal limit arenas for field or lab applications. We also provide a reporting checklist as a reference for researchers when carrying out experiments and preparing manuscripts. Future studies incorporating critical thermal limits would benefit from transparent reporting of warming/cooling rates (raw data, supplementary graphs) and photo/video evidence showing arena designs and critical thermal limit end points. We also provide directions for empirical research that will help further inform the measurement of critical thermal limits, including biotic factors like stress and digestion, warming/cooling rates, the effects of body mass on heat transfer and the physiological mechanisms underlying thermal tolerance.

The Coronavirus 2019 (COVID-19) pandemic disproportionately affected people living and working in care homes. This study aimed to explore the experience of care home managers on the implementation and uptake of the COVID-19 vaccination programme by residents and staff in care homes in Northern Ireland. An exploratory mixed methods approach was used, i.e., semi-structured interviews to design the cross-sectional survey and content analysis of statements using open ended questions. Care home managers were approached and sixty-seven valid quantitative and forty-nine descriptive responses were analysed. The study identified eight themes which described factors that motivated residents (family visits and relationship with managers and staff), and staff vaccine uptake (return to normal life at work and trust in care home managers). The identified themes also confirmed that vaccine uptake is negatively influenced by perceived side effects. The findings indicated that social media can promote or decelerate the uptake of vaccine despite the accessibility to a successful vaccination programme. The study highlights the important role of managers in handling the challenges through building trust and establishing relationships with staff and residents. The findings identified challenges to the uptake of the COVID-19 vaccine by staff and residents that can inform the implementation of future vaccination programmes.

Because most women of childbearing age are immune to VZV, congenital varicella syndrome is rare. Ultrasound result showed fetal abnormalities, including abnormal profile (small chin and suspected orbit anomaly), absent cavum septum pellucidum, left orbit/lens abnormality, abnormal flexion of arms and legs with no movement, complex cardiac defect, and echogenic bowel; suboptimal fetus’s abdominal cord insertion and sex identification. PMID:23863705 Jessica Leung, MPH1; Heather D. Reid2; Jodi Morgan2; Heather Kadyk3; Gayla Havener3; Mona Marin, MD1 1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 2Illinois Department of Public Health; 3Sangamon County Health Department, Springfield, Illinois.

Marine occupations are plagued by some of the highest accident and mortality rates of any occupation, due in part to the variety and severity of environmental hazards presented by the ocean environment. In order to better study and communicate the potential impacts of these hazards on occupational health and safety, a semi-objective, hazard-focused climatology of a particularly dangerous marine environment (Northwestern Atlantic) has been developed. Specifically, climate has been summarized as the frequency with which responsible government agencies are expected to issue relevant warnings or watches, couching results in language relevant to marine stakeholders. Applying cluster analysis to warning/watch frequencies identified seven distinct ‘hazard climatologies’, ranging from near-Arctic conditions to areas dominated by calm seas and warm waters. Spatial and temporal variability in these clusters reflects relevant annual cycles, such as the advance/retreat of sea ice and shifts in the Atlantic storm track; the clusters also highlight regions and seasons with comparable operational risks. Our approach is proposed as an effective means to summarize and communicate marine risk with stakeholders, and a potential framework for describing climate change impacts.

What is already known about this topic? Measles is a highly contagious vaccine-preventable disease. In the United States, 2 doses of measles, mumps, and rubella (MMR) vaccine are recommended for all children aged 12–15 months and 4–6 years. What is added by this report? During October 5–November 1, 2023, five measles cases occurred in unvaccinated, vaccine-eligible children aged 1–9 years who lived in the same apartment building but did not socialize with one another. During the outbreak, approximately 400 persons were exposed to measles, including 13 children aged <1 year. What are the implications for public health practice? Two doses of appropriately spaced MMR vaccine are recommended for all children and other susceptible persons to prevent measles cases and outbreaks.

The inspiration for this paper came rather unexpectedly. In February 2006, I made the long trip from my home in Sioux City, Iowa, to Torino, Italy in order to witness the Olympic Winter Games. Barely a month later, I found myself in California at the newly-renovated Getty Villa, home to one of the world's great collections of Greco-Roman antiquities. At the Villa I attended a talk about a Roman mosaic depicting a boxing scene from Virgil's Aeneid. The tiny tiles showed not only two boxers, but a wobbly looking ox. ‘What is wrong with this ox?’ asked the docent. ‘Why is he there at the match?’ The answer, of course, is that he is the prize. And the reason he is wobbly is because the victor has just sacrificed this prize to the gods in thanksgiving, by punching him between the eyes. A light went on in my head; I turned to my husband and whispered, ‘Just like Joey Cheek in Torino.’ My husband smiled indulgently, but my mind was already racing. I realized that by donating his victory bonus to charity, Cheek had tapped into one of the oldest and most venerable traditions in sport: individual sacrifice for the benefit of the larger community. It is a tradition that derives from the religious function of the ancient Olympic Games and it deserves to be revived the modern world.

Syndromic polymerase chain reaction (PCR) panels are used to test for pathogens that can cause rash illnesses, including measles. Rash illnesses have infectious and noninfectious causes, and approximately 5% of persons experience a rash 7-10 days after receipt of a measles, mumps, and rubella (MMR) vaccine. MMR vaccine includes live attenuated measles virus, which is detectable by PCR tests. No evidence exists of person-to-person transmission of measles vaccine virus, and illness does not typically result among immunocompetent persons. During September 2022-January 2023, the Tennessee Department of Health received two reports of measles detected by syndromic PCR panels. Both reports involved children (aged 1 and 6 years) without known risk factors for measles, who were evaluated for rash that occurred 11-13 days after routine MMR vaccination. After public health responses in Tennessee determined that both PCR panels had detected measles vaccine virus, six state health departments collaborated to assess the frequency and characteristics of persons receiving a positive measles PCR panel test result in the United States. Information was retrospectively collected from a commercial laboratory testing for measles in syndromic multiplex PCR panels. During May 2022-April 2023, among 1,548 syndromic PCR panels, 17 (1.1%) returned positive test results for measles virus. Among 14 persons who received a positive test result and for whom vaccination and case investigation information were available, all had received MMR vaccine a median of 12 days before specimen collection, and none had known risk factors for acquiring measles. All positive PCR results were attributed to detection of measles vaccine virus. Increased awareness among health care providers about potential measles detection by PCR after vaccination is needed. Any detection of measles virus by syndromic PCR testing should be immediately reported to public health agencies, which can use measles vaccination history and assessment of risk factors to determine the appropriate public health response. If a person recently received MMR vaccine and has no risk factors for acquiring measles, additional public health response is likely unnecessary.

Mumps is an acute viral disease characterized by fever and swelling of the parotid or other salivary glands. On May 1, 2015, the Illinois Department of Public Health (IDPH) confirmed a mumps outbreak at the University of Illinois at Urbana-Champaign. IDPH and the Champaign-Urbana Public Health District (C-UPHD) conducted an investigation and identified 317 cases of mumps during April 2015-May 2016. Because of sustained transmission in a population with high 2-dose coverage with measles-mumps-rubella (MMR) vaccine, a third MMR dose was recommended by IDPH, C-UPHD, and the university's McKinley Health Center. No formal recommendation for or against the use of a third MMR dose has been issued by the Advisory Committee on Immunization Practices (ACIP) (1). However, CDC has provided guidelines for use of a third dose as a control measure during mumps outbreaks in settings in which persons are in close contact with one another, where transmission is sustained despite high 2-dose MMR coverage, and when traditional control measures fail to slow transmission (2).