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Surveillance Summary: Abortion Surveillance — United States, 2019

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Enterovirus D68-Associated Acute Respiratory Illness ─ New Vaccine Surveillance Network, United States, July–November 2018–2020

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Enterovirus D68 (EV-D68) can cause serious respiratory illness in children and is linked with acute flaccid myelitis (AFM), a rare but serious condition that affects the spinal cord and can lead to paralysis. Despite an expected increase in cases in 2020, testing of children with acute respiratory illness (ARI) at seven U.S. medical centers detected fewer EV-D68 infections in 2019 and 2020, as compared to 2018.

EV-D68 generally circulates in the United States during the late summer and fall, with year-to-year fluctuations. The specimens in this study were collected during July through November 2018-2020 from seven U.S. medical centers that are part of the New Vaccine Surveillance Network, a surveillance platform for acute respiratory illness among children younger than 18 years of age. Increases in EV-D68 infections were previously observed in the United States in 2014 and 2016, suggesting an every-other-year pattern in EV-D68 circulation. EV-D68 was detected in 10.8% of specimens in 2018, but in only 0.2% of specimens in 2019 and 1.4% in 2020. Compared with 2018, the children tested in 2020 with positive EV-D68 were older (2.9 years vs. 5.3 years) and more often female (39.3% vs. 63.3%). Among the 36 children with EV-D68 detected in respiratory specimens in 2019 and 2020, most were Black or Hispanic. In 2020, asthma or reactive airway disease were reported in nearly half (14; 46.7%) of patients in whom EV-D68 was detected. Health disparities by race and ethnicity have been reported for respiratory illness, including increased risk for asthma and asthma exacerbations among Black persons in the United States, but more work is needed to better understand health disparities associated with EV-D68. While it’s unclear if the previous pattern of circulation will resume in the future, ongoing monitoring of this respiratory virus is needed to inform clinical and public health preparedness for acute respiratory illness and AFM associated with EV-D68, as well as to address possible health disparities.
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Forced Sexual Initiation and Early Sexual Debut and Associated Risk Factors and Health Problems Among Adolescent Girls and Young Women — Violence Against Children and Youth Surveys, Nine PEPFAR Countries, 2007–2018

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HIV prevention programs are needed to delay sexual debut and protect adolescent girls and young women from forced sex.

An analysis of Violence Against Children and Youth Survey data published by CDC highlighted the prevalence and factors associated with early sexual debut and forced sexual initiation. The survey, conducted in nine African countries from 2007-2018, shows that early sexual debut and forced sexual initiation are associated unsafe sexual behaviors. Adolescent girls and young women aged 13–24 years are disproportionately affected by HIV in sub-Saharan Africa resulting from biological, behavioral, and structural factors, including violence. Preventing sexual violence and early sexual debut are vital components of CDC and PEPFAR-supported programs to control the HIV epidemic. Comprehensive violence and HIV prevention programming is needed to delay sexual debut and protect adolescent girls and young women from forced sex.

Racial, Ethnic, and Gender Disparities in Awareness of Preexposure Prophylaxis Among HIV-Negative Heterosexually Active Adults at Increased Risk for HIV Infection — 23 Urban Areas, United States, 2019

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In 2019, awareness of the medication that prevents sexually acquired HIV infection — known as preexposure prophylaxis (PrEP) — was low among sexually active heterosexual adults at increased risk for HIV infection in select metropolitan areas, especially among Hispanic/Latino(a) adults.

National HIV Behavioral Surveillance (NHBS) conducts interviews and HIV testing among populations at high risk for HIV infection in selected metropolitan areas. Heterosexual sex is the identified route of transmission for 23% of new HIV diagnoses. CDC analyzed NHBS data to describe PrEP awareness among sexually active heterosexual adults in select cities and found that only 32% of those who were interviewed reported being aware of PrEP. Racial/ethnic and gender differences existed, with particularly low PrEP awareness among Hispanic/Latino men (about 20%) and Hispanic/Latina women (about 18%). These findings highlight the need for increased provider-patient communication about PrEP during routine health screenings and primary care visits, and tailored heterosexual and Spanish-language resources and campaigns to increase PrEP awareness and reduce disparities in use.

Previously Released: Risk for Stillbirth Among Women With and Without COVID-19 at Delivery Hospitalization — United States, March 2020–September 2021

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Previously Released: COVID-19–Associated Deaths After SARS-CoV-2 Infection During Pregnancy — Mississippi, March 1, 2020–October 6, 2021

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• Testing for Nonprescribed Fentanyl and Percentage of Positive Test Results Among Patients with Opioid Use Disorder — United States, 2019–2020A decline in drug monitoring disproportionately affected patients receiving medications for opioid use disorder (MOUD) during March–May 2020 and continued through the end of 2020. The percentage of positive urine test results for nonprescribed fentanyl among patients receiving MOUD reached 40.5% in April 2020. Increases in the percentage of positive urine drug tests for nonprescribed fentanyl and declines in drug testing could indicate disruptions in patient monitoring and treatment. These findings highlight the urgency of continuing and expanding access to MOUD and other treatment and harm reduction services during the COVID-19 pandemic.
• The percentage of urine samples in Quest Diagnostics testing positive for nonprescribed fentanyl among patients receiving MOUD increased in the beginning of the COVID-19 pandemic. By April 2020, 40.5% of samples among MOUD patients tested positive for nonprescribed fentanyl. Positive results for nonprescribed fentanyl declined toward the end of the year, with 18.5% testing positive at the end of December 2020. But levels of drug testing in this group were also 43% lower during September–December 2020 (weeks 35–52) compared to the same months in 2019. For the same time period, the numbers of specimens tested among patients not receiving MOUD were only 13% lower in 2020 compared with 2019. Nonprescribed fentanyl positivity rates among MOUD patients exhibited different patterns than among non-MOUD patients. Taken together with the decline in urine drug testing rates in MOUD patients, these findings could indicate disruptions in patient monitoring and highlight the urgency of continuing and expanding access to MOUD and other treatment and harm-reduction services. This is especially pertinent with the acceleration of overdose deaths involving synthetic opioids excluding methadone (primarily illicitly manufactured fentanyl) during the COVID-19 pandemic.

• Percentage of Births to Mothers Who Reported Smoking Cigarettes at Any Time During Pregnancy, by Urbanization Level of County of Residence — United States, 2020

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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.