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Using data from 12 US health departments, we estimated mean serial interval for monkeypox virus infection to be 8.5 (95% credible interval 7.3-9.9) days for symptom onset, based on 57 case pairs. Mean estimated incubation period was 5.6 (95% credible interval 4.3-7.8) days for symptom onset, based on 35 case pairs.

Objectives. To examine the potential impact of contact tracing to identify contacts and prevent mpox transmission among gay, bisexual, and other men who have sex with men (MSM) as the outbreak expanded. Methods. We assessed contact tracing outcomes from 10 US jurisdictions before and after access to the mpox vaccine was expanded from postexposure prophylaxis for persons with known exposure to include persons at high risk for acquisition (May 17–June 30, 2022, and July 1–31, 2022, respectively). Results. Overall, 1986 mpox cases were reported in MSM from included jurisdictions (240 before expanded vaccine access; 1746 after expanded vaccine access). Most MSM with mpox were interviewed (95.0% before vaccine expansion and 97.0% after vaccine expansion); the proportion who named at least 1 contact decreased during the 2 time periods (74.6% to 38.9%). Conclusions. During the period when mpox cases among MSM increased and vaccine access expanded, contact tracing became less efficient at identifying exposed contacts. Public Health Implications. Contact tracing was more effective at identifying persons exposed to mpox in MSM sexual and social networks when case numbers were low, and it could be used to facilitate vaccine access. (Am J Public Health. 2023;113(7):815–818. https://doi.org/10.2105/AJPH.2023.307301 )

In August 2022, the Florida Department of Health (FDOH) was notified of a suspected case of monkeypox in an infant aged <2 months who was admitted to a Florida hospital with a rash and cellulitis. This case report highlights findings from the related epidemiologic investigation and describes the public health actions taken. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.* This is the youngest patient with confirmed monkeypox infection in Florida to date.

What is already known about this topic? Nontuberculous mycobacteria (NTM) have been reported as a cause of health care–associated infections. What is added by this report? Investigation of a case of NTM infection in a patient who received a cosmetic surgical procedure in Florida identified a total of 15 cases in nine states in patients who received cosmetic surgical procedures at the same facility in Florida. Multiple lapses in infection control and prevention were found at an outpatient cosmetic surgery clinic operating with the same staff members. What are the implications for public health practice? Health care providers should have a high index of suspicion for extrapulmonary NTM when evaluating patients for postsurgical infection after cosmetic procedures and should be aware of the threshold for notifying public health officials of these cases.

During May 2022-April 2023, dengue virus serotype 3 was identified among 601 travel-associated and 61 locally acquired dengue cases in Florida, USA. All 203 sequenced genomes belonged to the same genotype III lineage and revealed potential transmission chains in which most locally acquired cases occurred shortly after introduction, with little sustained transmission.

As of November 14, 2022, monkeypox (mpox) cases had been reported from more than 110 countries, including 29,133 cases in the United States.* Among U.S. cases to date, 95% have occurred among males (1). After the first confirmed U.S. mpox case on May 17, 2022, limited supplies of JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) were made available to jurisdictions for persons exposed to mpox. JYNNEOS vaccine was approved by the Food and Drug Administration (FDA) in 2019 as a 2-dose series (0.5 mL per dose, administered subcutaneously) to prevent smallpox and mpox disease. On August 9, 2022, FDA issued an emergency use authorization to allow administration of JYNNEOS vaccine by intradermal injection (0.1 mL per dose) (2). A previous report on U.S. mpox cases during July 31-September 3, 2022, suggested that 1 dose of vaccine offers some protection against mpox (3). This report describes demographic and clinical characteristics of cases occurring ≥14 days after receipt of 1 dose of JYNNEOS vaccine and compares them with characteristics of cases among unvaccinated persons with mpox and with the vaccine-eligible vaccinated population in participating jurisdictions. During May 22-September 3, 2022, among 14,504 mpox cases reported from 29 participating U.S. jurisdictions, 6,605 (45.5%) had available vaccination information and were included in the analysis. Among included cases, 276 (4.2%) were among persons who had received 1 dose of vaccine ≥14 days before illness onset. Mpox cases that occurred in these vaccinated persons were associated with lower percentage of hospitalization (2.1% versus 7.5%), fever, headache, malaise, myalgia, and chills, compared with cases in unvaccinated persons. Although 1 dose of JYNNEOS vaccine offers some protection from disease, mpox infection can occur after receipt of 1 dose, and the duration of protection conferred by 1 dose is unknown. Providers and public health officials should therefore encourage persons at risk for acquiring mpox to complete the 2-dose vaccination series and provide guidance and education regarding nonvaccine-related prevention strategies (4).

Is there an early developing neuro-cognitive structure that is specific to our moral sense? Recent research has begun to explore this question using a classic thought experiment known as the trolley problem. These “trolley studies” have uncovered what appears to be a universal pattern of moral intuitions in adults that some argue can only be explained by assuming implicit knowledge of complex moral principles. In this dissertation, I build on this work by testing preschoolers’ and adults’ tacit knowledge of the principle of double effect – a principle that has a long history within the fields of philosophy, religion, and law, and which has recently been proposed to underlie our moral intuitions in the trolley problem. I also investigate the role of perceived ingroup/outgroup structure in moral judgment – a factor which others have hypothesized to be a foundation of moral judgment. Across three studies, preschoolers (studies 1 and 2) and adults (study 3) were tested on a series of dilemmas that were similar in structure to the traditional trolley problems, but involved property violations and assault (i.e. the apprehension of bodily harm) rather than “personal” violations such as battery or homicide. In all three studies, participants showed a strong and stable pattern of intuitions consistent with the principle of double effect: dilemmas in which an individual was harmed as a foreseen side effect of saving five people were judged favorably, but dilemmas in which an individual was intentionally harmed as a means to saving five people were judged unfavorably. Four-year-olds and adults (but not three-year-olds) also disapproved of scenarios in which an agent knowingly allowed a preventable harm to occur. Manipulations of minimal ingroup/outgroup structure had little to no effect on either preschoolers’ or adults’ moral judgments in these dilemmas. Implications for the structure and development of moral judgment are discussed.

Bipolar disorder and borderline personality disorder are common psychiatric diagnoses. One is a mood disorder with a strong genetic basis while the other is a disorder of personality commonly related to abusive experiences in childhood. Despite contrasting aetiologies they can be difficult to differentiate because of overlapping clinical presentations and symptoms. Diagnostic accuracy is important because of their polarised treatment approaches: long term treatment with mood stabilizers for bipolar disorder and psychotherapy for borderline personality disorder. A qualitative study of psychiatrists revealed comprehensive knowledge of the diagnostic criteria however, many expressed the view that diagnostic criteria did not assist diagnostic differentiation. These findings were validated in a large electronic survey of UK psychiatrists. A detailed study of actual diagnostic processes revealed that this scepticism appeared to influence actual practice. Clinicians largely ignored diagnostic criteria but continued to give diagnoses. Age and IQ matched women with bipolar disorder, borderline personality disorder and a healthy control group were compared in a series of cognitive tasks. Borderline personality disorder was associated with a failure to establish and maintain reciprocal cooperation in a game theoretic measure of social exchange. This behavioural change was not seen in euthymic bipolar disorder. Borderline personality disorder was also associated with an insensitivity to reward and losses in a risky decision-making task. Using a simple two-choice reaction task post error slowing was significantly amplified in the borderline group despite overall reaction times and error rates being similar in all three groups. Clinical diagnostic practice as revealed in this study is not adequate to reliably differentiate between bipolar disorder and borderline personality disorder. Laboratory measures of social exchange, decision making and post-error slowing highlight fundamental difficulties in borderline personality disorder not seen in euthymic bipolar disorder. These findings support the differentiation of bipolar disorder from borderline personality disorder and offer translational models for developing and evaluating new treatments for borderline personality disorder.

A thought experiment known as the trolley problem has frequently been used to examine whether adult moral judgments follow utilitarian principles; for example, maximize happiness for the greatest number. Previous research has shown that adults find it morally permissible to harm one person to save five others only when the harm to one is a foreseen side effect of saving five, but not when the harm to one is deliberately intended as the means to saving five. However, when asked to justify this moral intuition, few adults can articulate the principles guiding their judgment, suggesting that our moral judgments may be rooted in unconscious processes that evaluate the causal and intentional properties of an event. The current study tested 54 children on age-appropriate trolley dilemmas to examine whether young children make this distinction between harm as side effect and harm as a main effect. Our research indicates that like adults, preschoolers favor a utilitarian outcome when harming one person is simply a foreseen side effect of saving five others, but not when harming one person is the main effect of saving five.