Mariel Asbury Marlow

Objectives: People with HIV (PWH) who transition back into the community after incarceration often experience treatment disruptions, increasing the risk of poor outcomes. We examined factors associated with sustained viral suppression (SVS) after release. Methods: We analyzed 2015-2022 data from a nationally representative sample of PWH (N = 1012). We used weighted percentages and 95% CIs to describe the characteristics of recently incarcerated PWH by postrelease SVS status. We calculated prevalence ratios (PRs) to identify factors associated with SVS. Results: Among PWH who were incarcerated at least once in the past 12 months, only 30.0% achieved SVS postrelease. PWH aged 18 to 29 years (PR = 1.16; 95% CI, 1.01-1.32) and 30 to 39 years (PR = 1.20; 95% CI, 1.06-1.35) were significantly more likely to not have SVS than PWH aged ≥50 years. PWH released within 180 days (≤60 days: PR = 1.44; 95% CI, 1.29-1.61; 61-180 days: PR = 1.18; 95% CI, 1.03-1.34) were significantly more likely to not have SVS than PWH released after ≥181 days. PWH with ≥3 incarcerations within the past 12 months were significantly more likely to not have SVS than PWH who were incarcerated once (PR = 1.25; 95% CI, 1.12-1.39). PWH with SVS were significantly more likely to be retained in HIV care (PR = 1.55; 95% CI, 1.40-1.70), taking antiretroviral therapy (ART) (PR = 1.20; 95% CI, 1.14-1.28), or adherent to ART (PR = 1.34; 95% CI, 1.15-1.56) than PWH without SVS. Conclusions: SVS outcomes among recently incarcerated PWH could improve through adherence support, discharge planning, and postrelease support, particularly for young or frequently incarcerated individuals.

Objective: During January 2016–June 2017, 75 mumps outbreaks occurred in US universities, despite high vaccine coverage among students. We evaluated universities’ experiences with mumps outbreaks to inform policy deliberations on use of a third dose of MMR vaccine and CDC guidance. Participants: American College Health Association members in September 2017. Methods: Online survey assessing mumps outbreak characteristics and response measures distributed to 980 members. Results: Administrators from 251 (26%) universities from 47 states responded. Seventy-nine (31%) universities had mumps cases on campus during August 2014–August 2017; 17 (22%) recommended a third MMR dose. The main challenges reported in outbreak response were exclusion of persons without presumptive immunity and isolation of students with mumps. Universities’ advice on addressing challenges is described. Conclusion: We identified common challenges faced by universities during mumps outbreaks, and lessons learned. These findings informed the October 2017 recommendation for use of a third MMR dose.

Objectives. To present the first update on the epidemiology of US foodborne correctional institution outbreaks in 20 years. Methods. We analyzed data from the Centers for Disease Control and Prevention’s Foodborne Disease Outbreak Surveillance System to describe correctional institution outbreaks from 1998 to 2014 and compare them with other foodborne outbreaks. Results. Two hundred foodborne outbreaks in correctional institutions were reported, resulting in 20 625 illnesses, 204 hospitalizations, and 5 deaths. Median number of outbreak-associated illnesses per 100 000 population per year was 45 (range = 11–141) compared with 7 (range = 4–10) for other outbreaks. These outbreaks accounted for 6% (20 625 of 358 330) of outbreak-associated foodborne illnesses. Thirty-seven states reported at least 1 outbreak in a correctional institution. Clostridium perfringens (28%; 36 of 128) was the most frequently reported single etiology. The most frequently reported contributing factor was food remaining at room temperature (37%; 28 of 76). Conclusions. Incarcerated persons suffer a disproportionate number of outbreak-associated foodborne illnesses. Better food safety oversight and regulation in correctional food services could decrease outbreaks. Public Health Implications. Public health officials, correctional officials, and food suppliers can work together for food safety. Clearer jurisdiction over regulation of correctional food services is needed.

Although known to be highly endemic in the Amazon regions of Brazil, the presence of cutaneous leishmaniasis (CL) in the subtropical southern part of the country has largely been ignored. This study was conducted to demonstrate CL is emerging in the Brazilian state of Santa Catarina, as well as to characterize the epidemiological profile and Leishmania species involved. For this cross-sectional study, data from all CL cases from Santa Catarina, Brazil, reported to the Brazilian National Notifiable Diseases Information System from 2001 to 2009 were investigated. Amplification of the kDNA minicircle conserved region followed by restriction fragment length polymorphism (PCR-RFLP) was conducted to screen for Leishmania species present in patient biopsy. Overall, 542 CL cases were reported, with majority resulting from autochthonous transmission (n = 401, 73.99%) and occurring in urban zones (n = 422, 77.86%). Age, gender, zone of residence, origin of case, clinical form and case outcome were found to differ significantly by region. Imported cases were over seven times more likely to relapse (95% CI 2.56–21.09). Mapping of cases revealed new endemic areas in northeastern Santa Catarina with two species present. With the exception of three L. (Leishmania) amazonensis cases (1.20%), majority of PCR positive samples were found to be L. (Viannia) braziliensis (n = 248, 98.80%). CL is now endemic in the state of Santa Catarina, Brazil, with case profiles varying significantly by region. L. (V.) braziliensis has been identified as the predominant species in the region.