Emily W. Lankau

1. 1.1. The National Research Blueprint (NRB) proposes a change in how inheritable bleeding disorders (BD) research in the U.S. is conducted and who it engages: a Bleeding Disorders Research Collab...

Objective: The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion work (hereafter, Chronic Disease Directors). In this paper, we report on the 2024 survey outcomes and place those findings into the broader public health policy context. Design: Fifty-one Chronic Disease Directors completed the organizational capacity and development needs survey. Responses were summarized in aggregate and by jurisdiction size. Results: State and territorial chronic disease units have varied responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors reported strong or improving capacity in most practice areas but ranked workforce development lower than other areas. Staffing decreased slightly during 2024 compared with 2023 (median of 1.1 and 1.3 employees per 100 000 jurisdiction population, respectively). Many Chronic Disease Directors expressed ongoing concerns about staff turnover and workforce development, funding limitations and stability, and the effects of the political climate on public health work. Despite these challenges, many respondents also conveyed success stories about program achievements, obtaining new funding, and building partnerships and collaborations. Looking forward to 2025, many Chronic Disease Directors expressed intentions to focus on leadership, policy, and technical training; on making structural and staffing changes within their units; and on continuing to build cross-sector relationships and collaborations. Conclusions: Continued concerns about staff turnover and workforce development underscore the need to better understand and remove barriers to capacity building in this area to support job satisfaction and employee retention. Changes to federal infrastructure are likely to have substantial impacts and may increase reliance on cross-sector partnerships to continue advancing chronic disease prevention and health promotion.

Context: Chronic diseases are leading causes of death and disability in the United States and have disproportionate impacts in our communities due to demographic, geographic, and socioeconomic factors that affect health outcomes. Limitations in timeliness, representativeness, and granularity of chronic disease data hinder efforts to understand trends, factors contributing to differences in health outcomes, and community needs. Discussion: In this paper, we explore strengths and gaps in chronic disease surveillance capacity in the United States. Then we consider similarities and differences between chronic and infectious disease surveillance needs and approaches. Finally, we make the case for working towards a more comprehensive and integrated approach to data modernization that prioritizes the leading causes of death, disability, and differences in health outcomes in our communities, regardless of etiology, to build a public health surveillance ecosystem that can provide the timely, representative, and local data required to develop responsive and effective health policies and community-based interventions.

Objective: The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD’s 2023 survey outcomes and place those findings into the broader public health policy context. Design: State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size. Results: State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity. Conclusions: During this period of pandemic recovery, turnover, hiring, and training—particularly of the many new public health staff—remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development—particularly workforce development, chronic disease data systems, and tools for addressing health equity—could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion.

Diagnostic laboratories receive carcasses and samples for diagnostic evaluation and pathogen/toxin detection. Case definitions bring clarity and consistency to the evaluation process. Their use within and between organizations allows more uniform reporting of diseases and etiologic agents. The intent of a case definition is to provide scientifically based criteria for determining (a) if an individual carcass has a specific disease and degree of confidence in that diagnosis and (b) if there is evidence of a pathogen or toxin in a carcass or sample (for example, swab, tissue sample, skin scraping, blood/serum sample, environmental sample, or other). This case definition template can be used for any disease/pathogen for any species. An editable version of this template is available for download at https://doi.org/10.3133/tm19A1.

Common scab, caused by Streptomyces scabies and related species, is a potato tuber blemish disease that causes reductions in marketable yield worldwide. Evidence of suppression of common scab by indigenous soil microbial populations has been found in several studies. However, we lack a comprehensive understanding of how common scab severity relates functionally to potato varieties, farming systems, soil physical and chemical properties, and soil microbial communities. These factors may affect disease directly or indirectly by affecting one of the other variables. We performed a survey of 30 sampling locations across 12 fields in Wisconsin and used structural equation modeling to disentangle the direct effects of potato market classes, farm management (conventional versus organic), and soil physiochemical properties on common scab severity from their indirect effects mediated through soil bacterial and fungal communities. We found that, although potato market classes affected disease severity directly, the effects of farm management and soil physiochemistry were best explained as indirect, mediated by their impacts on soil bacterial communities. This suggests that evaluating the consequences of specific management practices for soil microbial communities may be useful for understanding disease pressure across fields.

Microbial communities in the gastrointestinal tract influence many aspects of host health, including metabolism and susceptibility to pathogen colonization. These relationships and the environmental and individual factors that drive them are relatively unexplored for free-living wildlife. We quantified the relationships between urban habitat use, diet, and age with microbiome composition and diversity for 82 American white ibises (Eudocimus albus) captured along an urban gradient in south Florida and tested whether gut microbial diversity was associated with Salmonella enterica prevalence. Shifts in community composition were significantly associated with urban land cover and, to a lesser extent, diets higher in provisioned food. The diversity of genera was negatively associated with community composition associated with urban land cover, positively associated with age class, and negatively associated with Salmonella shedding. Our results suggest that shifts in both habitat use and diet for urban birds significantly alter gut microbial composition and diversity in ways that may influence health and pathogen susceptibility as species adapt to urban habitats.

Background: Wild birds using livestock facilities for food and shelter may contribute to dissemination of enteric pathogens or antimicrobial resistant bacteria. However, drivers of microbial exchange among wildlife and livestock are not well characterized. Predisposition for acquiring and retaining environmental bacteria may vary among species because of physiologic or behavioral differences, complicating selection of a bacterial model that can accurately characterize microbial connections among hosts of interest. This study compares the prevalence and antibiotic resistance phenotypes of two potential model bacterial organisms isolated from wild birds and their environments.Methods: We compared prevalence and resistance profiles ofEscherichia coliandEnterococcusspecies isolated from environmental swabs and bird feces on a residential control site, a confinement dairy, a pasture-based beef farm, and a confinement beef farm.Results: Bird feces at all sites had low-to-moderate prevalence ofEscherichia coli(range: 17–47%), despite potential for exposure on farms (range: 63–97%). FewEscherichia coliwere isolated from the control environment.Enterococcus faecaliswas dominant in birds at both beef farms (62% and 81% ofEnterococcusisolates) and low-to-moderately prevalent at the dairy and control sites (29% and 23% of isolates, respectively). Antimicrobial resistance prevalence was higher in farm samples compared to those from the residential control, but distribution of resistant isolates varied between the bacterial genera. Birds on all farms carried resistantEnterococcusat similar rates to that of the environment, but resistance was less common in bird-associatedEscherichia colidespite presence of resistant isolates in the farm environment.Discussion: Bacterial species studied may affect how readily bacterial exchange among populations is detected. Selection of microbial models must carefully consider both the questions being posed and how findings might influence resulting management decisions.

Summary: Controlling rabies in skunk populations is an important public health concern in many parts of the United States due to the potential for skunk rabies outbreaks in urban centres and the possible role for skunks in raccoon rabies variant circulation. Oral rabies vaccination (ORV) programmes have supported wildlife rabies control efforts globally but using ORV to control rabies in skunk populations has proven more challenging than with other target species, like foxes, coyotes and raccoons. A review of published studies found that some ORV constructs are immunogenic in skunks and protect against virulent rabies virus challenges, especially when delivered by direct installation into the oral cavity. However, in field ORV programmes using currently available vaccine‐bait formats and distribution methods targeting other rabies reservoir species, skunks often fail to seroconvert. Field effectiveness of ORV in skunks appears to be limited by poor bait uptake or inadequate ingestion of vaccine rather than from poor vaccine efficacy. Observations of captive skunks revealed vaccine spillage when handling and biting into baits such that modification of bait formats might improve field effectiveness. In addition, a dose–response relationship between bait distribution density and post‐baiting seroconversion among skunks was observed across the limited number of field studies. Additional research is needed to identify opportunities to modify ORV baits and distribution strategies to improve the viability of ORV as a rabies control strategy in skunks.

During 2002−15 we examined the causes of mortality in a population of northern sea otters (Enhydra lutris kenyoni). Beachcast sea otters were collected primarily from the US coast of Washington. Although there are no permanent sea otter residents in Oregon, several beachcast otters were collected from the Oregon coast. Infectious diseases were the primary cause of death (56%) for otters we examined. Sarcocystosis was the leading infectious cause of death (54%) and was observed throughout the study period. Some infectious diseases, such as morbilliviral encephalitis and leptospirosis, were documented for a limited number of years and then not detected again despite continued testing for these pathogens in necropsied animals. Trauma was the second most common cause of death (14%) during the study period. The continued stable growth of the Washington population of otters suggests they are able to tolerate current mortality rates.