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Supplement: Standards Required for the Development of CDC Evidence-Based Guidelines

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This report describes standards required for CDC guideline development. These standards apply to all CDC guidelines developed outside of an emergency response. In the United States and around the world, CDC is a principal source for public health and clinical guidelines. The methods and processes described in this report employ universally accepted standards to ensure CDC guidelines are clear, valid, and reliable.

Evaluation of State-Led Surveillance of Neonatal Abstinence Syndrome — Six U.S. States, 2018–2021

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Mandated neonatal abstinence syndrome (NAS) reporting helps quantify NAS incidence and inform programs and services. To review surveillance features and programmatic development in six states with mandated NAS case reporting for public health surveillance, a questionnaire and interview with state health department officials on postimplementation efforts were implemented in 2021. All states reported ongoing challenges with initial case reporting, limited capacity to track social and developmental outcomes, and no requirement for long-term follow-up; only one state instituted health-related outcomes monitoring. States considering neonatal abstinence syndrome (NAS) surveillance beyond initial case reporting might benefit from understanding opportunities and challenges related to necessary infrastructure and resource development to facilitate longer-term public health follow-up. Key challenges include persistent data collection issues, including lack of a standard clinical definition for NAS, and infrastructural gaps influencing states’ capacity for longer-term surveillance beyond initial case reporting. With resource- and capacity-building assessments and responding actions, state health departments might be better prepared to bridge the gap between initial case reporting and longer-term needs analysis and support for affected infants and families.

Trends in Breast Cancer Incidence, by Race, Ethnicity, and Age Among Women Aged ≥20 Years — United States, 1999–2018

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Rates of new breast cancer diagnoses (incidence) in U.S. women decreased from 1999 to 2004 but increased slightly from 2004 to 2018. Trends in breast cancer rates differed by age and racial/ethnic group. During 1999 to 2018, breast cancer incidence decreased among women 50-64 and 75 years or older but increased among women aged 20-39 years. Breast cancer is the most common cancer among women. CDC researchers analyzed U.S. Cancer Statistics data from 1999 to 2018 to examine trends in rates of new cases of breast cancer in women 20 years and older by race/ethnicity and age. The rate of new cases of breast cancer among women decreased by 2.1% per year from 1999 to 2004 but increased by 0.3% per year from 2004 to 2018. The study found that the change in rate of new cases differed by age and racial/ethnic group. In recent years, breast cancer incidence increased among non-Hispanic Asian or Pacific Islander, non-Hispanic White, and Hispanic women. During 1999 to 2018, breast cancer incidence decreased among women 50-64 and 75 years or older but increased among women aged 20-39 years. CDC’s Bring Your Brave campaign, which provides information about breast cancer to women under the age of 45, is one way CDC works to address disparities in breast cancer incidence, survival, and mortality among young women.

Impact of the DREAMS Program on New HIV Diagnoses in Adolescent Girls and Young Women Attending Antenatal Care — Lesotho, 2015–2020

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Three and a half years after implementing the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) program, new HIV diagnoses among adolescent girls and young women attending antenatal care decreased 71% in two districts in Lesotho, compared to a reduction of 48% in locations without the program. A study published by CDC of the first 3.5 years of the DREAMS program in Lesotho showed a substantial reduction in new HIV diagnoses among adolescent girls and young women attending antenatal care in both DREAMS and three non-DREAMS districts. The study shows a 71% reduction in new HIV diagnoses among adolescent girls and young women in two districts in Lesotho that implemented DREAMS program – a package of biomedical, behavioral, and structural interventions to address factors that make adolescent girls and young women vulnerable to HIV acquisition – compared with a reduction of 48% in three comparison districts without the program. The findings are important for Lesotho, a country with the second highest prevalence of HIV infection in the world (26% among people aged 15-59 years). Apart from the DREAMS program, the decrease in new HIV diagnoses might be a result of multiple interventions including the reduction in viral load in the population as more persons living with HIV became virally suppressed.

Previously Released: Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12–18 Years — United States, July–December 2021

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Previously Released: Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 years — United States, March 1, 2020–June 28, 2021

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• HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs — Kanawha County, West Virginia, 2019–2021In a West Virginia community experiencing an ongoing HIV outbreak among people who inject drugs, stigma and discrimination, as well as low access to syringe services programs, pose critical challenges to engaging people in HIV prevention and treatment. In May 2021, the West Virginia Bureau for Public Health requested CDC assistance following ongoing increases in HIV diagnoses among people who inject drugs (PWID) in Kanawha County, West Virginia. Interviews with PWID and community partners found PWID commonly reported reusing or sharing syringes due to low access to sterile syringes following closures of local syringe services programs (SSPs). PWID also expressed medical mistrust because of experiences of stigma and discrimination in healthcare settings. Among the patients whose medical records were analyzed, none were prescribed pre-exposure prophylaxis (PrEP) to prevent HIV and HIV testing was conducted infrequently.

• Percentage of Adults Aged ≥18 Years Who Received Care at Home From a Friend or Family Member in the Past 12 Months, by Sex and Age Group — National Health Interview Survey, United States, July–December 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.