Search

Meningococcal disease is a sudden-onset, life-threatening illness caused by the bacterium Neisseria meningitidis. Prompt empiric antibiotic treatment can reduce morbidity and mortality among patients, and antibiotic prophylaxis can prevent secondary disease in close contacts. Historically, N. meningitidis isolates in the United States have largely been susceptible to the antibiotics recommended for treatment and prophylaxis, including penicillin and ciprofloxacin. This report describes detection of penicillin-resistant and ciprofloxacin-resistant N. meningitidis serogroup Y (NmY) isolates in the United States. NmY isolates containing a blaROB-1 β-lactamase enzyme gene conferring resistance to penicillins (1) were recovered from 33 cases reported during 2013-2020. Isolates from 11 of these cases, reported during 2019-2020, harbored a ciprofloxacin resistance-associated mutation in a chromosomal gene (gyrA). Cases were reported from 12 geographically disparate states; a majority of cases (22 of 33, 67%) occurred in Hispanic persons. These cases represent a substantial increase in penicillin-resistant and ciprofloxacin-resistant meningococci in the United States since 2013. Ceftriaxone and cefotaxime, the recommended first-line agents for empiric bacterial meningitis treatment, can continue to be used for treatment, but health care providers should ascertain susceptibility of meningococcal isolates to penicillin before switching to penicillin or ampicillin. Ongoing monitoring for antimicrobial resistance among meningococcal isolates and prophylaxis failures will be important to inform treatment and prophylaxis recommendations.

OBJECTIVES: With the availability of curative therapies, it is important to ensure that individuals infected with hepatitis C virus (HCV) receive recommended testing, care, and treatment. We sought to evaluate insurance claims data as a source for monitoring progression along the HCV care cascade. STUDY DESIGN: Longitudinal evaluation of disease progression, from diagnosis to treatment, among commercially insured enrollees with chronic HCV. METHODS: We validated and used algorithms derived from standardized procedure and diagnosis codes to identify enrollees with chronic HCV in large insurance claims databases to describe the HCV care cascade, including the proportion engaged in HCV-specific care (13 possible definitions), the proportion prescribed HCV treatment, and the proportion who received an HCV RNA test 30 or more days after initiating treatment. RESULTS: Approximately 90% of individuals with an HCV RNA test procedure code followed by either 3 or more chronic HCV diagnosis codes on different service dates or 2 or more chronic HCV diagnosis codes separated by more than 60 days truly had chronic HCV. Using these algorithms, we identified 5791 HCV cases from January 1, 2013, to June 30, 2014. Among enrollees with HCV, 95% were engaged in HCV care, but only 49% initiated treatment and 43% received a follow-up HCV RNA test 30 or more days after initiating treatment. CONCLUSIONS: With validated case-finding algorithms, insurance claims data can be used to describe and monitor portions of the HCV care cascade. Although nearly all enrollees with HCV were engaged in HCV care, only half received treatment, indicating that even commercially insured enrollees may find it challenging to access treatment.

Background and aimsEffective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States (US). We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting.DesignAn ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from a HIV-outbreak investigation in Indiana.SettingScott County, Indiana (population 24,181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence amongst PWID in 2015ParticipantsPWIDMeasurementsRequired annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programs (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without retreatment of reinfections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting.FindingsTo achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 25% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 15%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (20%) need treatment annually. These treatment requirements are 3-fold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment.ConclusionsCombined scale-up of hepatitis C virus (HCV) treatment and prevention interventions is needed to decrease the increasing burden of HCV incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.

Background Pertussis is a highly contagious, vaccine-preventable respiratory disease. Historically, pertussis incidence was cyclic with peaks in disease every 3–5 years. In the United States, reported pertussis has increased over the past few decades despite high vaccination coverage; however, there is currently no clear national spatiotemporal pattern. We aimed to assess whether geographically distinct areas in the United States: (1) share similar temporal patterns (trend and periodicity), and (2) were synchronous in peaks in pertussis incidence. Methods We used pertussis cases reported through the National Notifiable Diseases Surveillance System, and CDC Wonder bridged-race county population estimates, for 2000–2017. County-level pertussis case counts were aggregated by month, and counties were aggregated into population areas of ≥300,000 persons. For each population area, trend and dominant periods across the study period were extracted using wavelet analysis. Common temporal patterns were identified using hierarchical cluster analysis of trend and periodicity. Synchrony between population area pairs, and between each area and the country as a whole, were assessed using wavelet coherence and phase difference. Results There was substantial variability in temporal patterns, though geographically distinct population areas clustered by trend and similar dominant periods of 8 to