MMWR News Synopsis

Articles

Sex Differences in HIV Testing — 20 PEPFAR-Supported Sub-Saharan African Countries, 2019

CDC Media Relations
404-639-3286

To achieve global HIV epidemic control by 2030, more effective strategies are needed to diagnose all people with HIV infection and start treatment, particularly among men as they are less likely than women to receive a HIV test. In 2014, the Joint United Nations Program on AIDS (UNAIDS) launched the 90–90–90 strategy for ending the global HIV pandemic: 90% of all HIV-positive persons should know their status; of these, 90% should receive antiretroviral treatment (ART); and of these, 90% should be virally suppressed. Despite progress toward controlling the global HIV epidemic, certain populations of people with HIV infection have low rates of HIV diagnosis, particularly men. An analysis of HIV testing data from 20 sub-Saharan African countries supported by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) shows that while 37% of HIV-positive results were among men, men are half as likely as women to receive an HIV test. To maximize the number of people with HIV infection who know their status, PEPFAR recommends identifying and implementing the most efficient HIV testing strategies, including provider-initiated testing and counseling (where providers recommend an HIV test as part of routine care) and index testing (where HIV testing services are offered to the partners and biologic children of people with HIV infection).

Multidisciplinary Community-Based Investigation of a COVID-19 Outbreak Among Marshallese and Hispanic/Latino Communities — Benton and Washington Counties, Arkansas, March–June 2020

CDC Media Relations
404-639-3286

Longstanding systemic health and social inequities have placed racial and ethnic minority groups at higher risk for severe outcomes of COVID-19, including hospitalization and death. Additional support, culturally and linguistically appropriate public health education, community-based prevention activities, case management, care navigation, and service linkage are needed to reduce COVID-19 cases and deaths among Marshallese and Hispanic or Latino people. By June 2020, although Marshallese (people who come from the Republic of the Marshall Islands (RMI)) and Hispanic or Latino (Hispanic) people made up 19% of the population in two Arkansas counties, these groups accounted for 64% of COVID-19 cases and 57% of COVID-19-related deaths. Compared to non-Hispanic white people, rates of COVID-19 among Marshallese people were 71 times higher, hospitalizations rates were 96 times higher, and COVID-19-related death rates were 65 times higher. Similarly, compared to non-Hispanic white people, rates of COVID-19 among Hispanic people were 15 times higher, hospitalization rates were 11 times higher, and COVID-19 death rates were three times higher. During focus group discussions and interviews, Marshallese and Hispanic people expressed their concerns about COVID-19. Challenges to following prevention and mitigation measures included: working conditions where COVID-19 incidence is high and physical distancing is not possible (such as in poultry processing facilities); little awareness of COVID-19 spread; limited health messaging in their native languages; high numbers of people living in a household; mistrust of the medical system; low utilization of medical care; and changing COVID-19 guidance. Communities that suffer disproportionately from COVID-19, especially those affected by long-standing inequities in social determinants of health, need culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.

Disproportionate Incidence of COVID-19 Infection, Hospitalizations, and Deaths Among Persons Identifying as Hispanic or Latino — Denver, Colorado March–October 2020

Jennifer Fine
Denver Public Health
Jennifer.Fine@dhha.org

Among cases of COVID-19 reported in Denver, Colorado during March–October, the majority of adult cases (55%), hospitalizations (62%), and deaths (51%) were among Hispanic or Latinos – double the percentage of Hispanic or Latino adults in the Denver community (25%). Public health, health systems, and social services need to address systemic inequalities to mitigate the disproportionate incidence of COVID-19 in Hispanic people. Investigators from Denver Public Health (DPH) conducted interviews or reviewed medical records for all people with laboratory-confirmed COVID-19 who lived in Denver, Colorado, during March 6-October 6. To evaluate health disparities, investigators analyzed the characteristics of people with COVID-19 diagnoses, hospitalizations, or deaths. They identified 10,163 cases of COVID-19 among adults living in non-congregate settings in Denver. Of 9,056 cases with race and ethnicity data, 4,959 (54.8%) were among Hispanic or Latino people, even though Hispanic or Latino people make up 25% of Denver’s population. Furthermore, a larger percentage of hospitalizations (62.1%) and deaths (51.2%) were among Hispanic or Latino people. Compared to non-Hispanic people, a higher percentage of Hispanic or Latino people who had COVID-19 symptoms reported working while ill (86.4% vs. 77.3%). Among 2,982 cases with employment data, a higher percentage of Hispanic or Latino people with COVID-19 reported working in essential industries (68.8% vs 60.2%). Among 3,917 cases with available data, a higher percentage of Hispanic or Latino people with COVID-19 reported living with more than five people (38.3% vs. 13.4%) and a higher percentage reported exposure to a person with known COVID-19 in the household (23.7% vs. 15.2%). Several factors leading to disproportionate exposure, such as crowded housing and lack of paid sick leave, are due to upstream social drivers and outside the traditional health care system. Public health and health care systems should partner with social service organizations and community health workers to address patients’ unmet social, medical, and mental health needs while providing culturally responsive information on COVID-19.

Regional Analysis of Coccidioidomycosis Incidence — California, 2000–2018

CDC Media Relations
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Coccidioidomycosis (Valley fever) is an infection caused by the soil-dwelling fungus Coccidioides spp., which can result in severe disease and, rarely, death. From 2000 to 2018, rates of Valley fever in California were highest in the Southern San Joaquin Valley, and the largest increase (15-fold) was in the Northern San Joaquin Valley. Across all regions, risk was consistently high among males and Black people. In California, rates of Valley fever increased by nearly 800% from 2000 (2.4 per 100,000 population) to 2018 (18.8 per 100,000 population). The California Department of Public Health conducted a regional analysis of data reported from 2000 to 2018. The analysis found rates of Valley fever were highest in the Southern San Joaquin Valley (90.6 per 100,00 population), and the largest increase (15-fold) was in the Northern San Joaquin Valley. In all regions, rates were higher among males than females, and higher among Blacks than among other racial/ethnic groups. Rates varied across the regions for different age groups and Hispanic ethnicity. Currently, there are no known effective methods for primary prevention of coccidioidomycosis (e.g., a vaccine); therefore, widespread awareness is important for prompt early diagnosis, proper management, possible antifungal treatment, and better outcomes.

Survey of Teen Noise Exposure and Efforts to Protect Hearing at School — United States, 2020

CDC Media Relations
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Nearly half (47%) of middle and high school students are exposed to loud sounds at school on a regular basis. However, the majority of students were not provided with equipment to protect their hearing or taught how to reduce their risk of permanent noise-induced hearing loss (NIHL). Noise-induced hearing loss (NIHL) is a substantial, often unrecognized health problem. Even mild levels of hearing loss negatively affect auditory perception and cognitive skills. Schools can be noisy places with loud activities. One in every six to eight middle and high school students has measurable hearing loss likely resulting from excessive noise exposure. CDC analyzed data from a sample of 817 middle and high school students aged 12–17 years who responded to the web-based YouthStyles survey in 2020. Nearly half (46.5%) of students reported being exposed to loud sounds at school on a regular basis. The majority of students reported they were not provided with equipment to protect their hearing (85.9%) or taught how to reduce their risk of permanent noise-induced hearing loss (70.4%). Healthcare providers and educators have resources and tools to prevent NIHL among school-aged youths. Increasing youth awareness about the adverse health effects of excessive noise exposure and simple preventive measures to reduce risk can help prevent NIHL.

Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020 (Early Release, December 1, 2020)

CDC Media Relations
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• Interpretation of Rapid Diagnostic Tests for Leptospirosis During a Dengue Outbreak — Yap State, Federated States of Micronesia, 2019

In August 2019, Yap State, one of the four states of the Federated States of Micronesia, declared a public health crisis due to suspected concurrent outbreaks of dengue and leptospirosis. CDC laboratory testing confirmed a dengue outbreak but not a leptospirosis outbreak. The report highlights the need for improved laboratory capacity to distinguish between dengue and leptospirosis, which helps clinicians decide appropriate treatment since both diseases have similar symptoms. On August 30, 2019, Yap State, one of the four states of the Federated States of Micronesia, declared a public health crisis due to suspected concurrent outbreaks of dengue, a mosquito-borne viral illness, and leptospirosis, which is caused by a bacteria (Leptospira) found in water and soil contaminated by infected animal urine. Although both illnesses have similar symptoms (e.g., a fever), early antibiotic treatment for leptospirosis helps decrease the severity and duration of disease. The outbreak included 545 suspected dengue cases and 515 suspected leptospirosis cases during January–August 2019. A team of outbreak investigators from Yap State and CDC worked to identify suspected cases and confirm clinical diagnosis through laboratory testing conducted at CDC. Among 103 patients with samples tested, 44 (43%) had evidence of dengue virus infection, while five (5%) had evidence of Leptospira infection, including two patients who also had confirmed dengue virus infection. CDC laboratory testing confirmed a dengue outbreak but not a leptospirosis outbreak because the number of confirmed leptospirosis cases identified was similar to the expected average number of cases in the area. The report highlights the need for improved local laboratory capacity and rapid tests to distinguish between dengue and leptospirosis to help decide appropriate treatment for patients presenting with similar symptoms.

• Emergency Department Visit Rates Related to Mental Health Disorders, by Age Group and Sex — National Hospital Ambulatory Medical Care Survey, United States, 2016–2018

• Surveillance for Violent Deaths — National Violent Death Reporting System, 34 States, Four California Counties, the District of Columbia, and Puerto Rico, 2017

Violent deaths remain a serious but preventable public health problem in the United States. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for many violent deaths. For 2017, National Violent Death Reporting System collected information on 45,141 fatal incidents involving 46,389 deaths that occurred in 34 states, four California counties, and the District of Columbia. The majority of violent deaths in 2017 were suicides (63.5%) and homicides (24.9%), and the most common method of injury for both suicides and homicides were firearms. When homicide circumstances were known, approximately 42% of homicides among females were related to intimate partner violence. In addition, information was collected on 961 fatal incidents involving 1,027 deaths in Puerto Rico. Data from the National Violent Death Reporting System underscore relationship problems as a risk factor for both suicides and homicides, and the importance of developing social and emotional skills (e.g., communication, conflict resolution, and empathy) and supportive relationships as protective factors. CDC has developed technical packages to help states and communities use the best available evidence prevent violence.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.