CDC Foundation

Posttraumatic stress disorder (PTSD) during pregnancy is associated with adverse consequences and has an estimated prevalence of 3% in community samples. The prevalence of current PTSD among pregnant women with opioid use disorder (OUD), a population at increased risk of adverse birth outcomes and other mental disorders, has been estimated at 16%-37% based on 3 small studies. We used the Centers for Disease Control and Prevention's MATernaL and Infant clinical NetworK (MAT-LINK) surveillance network to (1) further examine current PTSD prevalence among pregnant women with OUD and (2) compare characteristics of those with and without PTSD. PTSD prevalence estimates during the current pregnancy were based on (1) presence of an ICD-9/10-CM code indicating PTSD (ie, extracted); (2) documentation of a PTSD diagnosis in abstracted data (ie, abstracted); and (3) PTSD identified by either source. Of 3315 pregnancies among women with OUD, estimated current PTSD prevalence was 14.7% (95% CI: 13.5-15.8) based on extracted data alone, 23.3% (95% CI: 22.0-24.6) based on abstracted data alone, and 25.9% (95% CI: 24.1-27.7) when based on either data source. Those with PTSD had a higher prevalence of most substance use and mental health disorders examined compared with those without. These estimates underscore the substantial prevalence of PTSD among pregnant women with OUD and emphasize the need to screen for and treat PTSD and other mental health disorders in this population. Given that evidence-based treatments for PTSD have not been systematically evaluated in pregnant women, more research is sorely needed.

Norovirus is the leading cause of medically attended acute gastroenteritis in the United States. Efforts to reduce the disease burden are constrained by uncertainty around fundamental aspects of norovirus epidemiology. This study describes characteristics of norovirus infections and explores potential risk factors for symptomatic infections in early life. The Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal birth cohort study followed 245 children from birth to 2 years of age with weekly stool sample collection and symptom surveys. Stool samples were tested by reverse transcriptase-realtime polymerase chain reaction to detect norovirus genogroup (G)I and GII; positive samples were genotyped. Infections accompanied by diarrhea and/or vomiting were considered symptomatic. Children were categorized as adherent if they participated for ≥18 months and submitted ≥70% of samples. A total of 72 GI and 330 GII norovirus infections (among 156 children) were identified. One-fifth (20.8%) of adherent children experienced ≥1 norovirus infection by 6 months of age, increasing to 84.2% children by 2 years of age. About one-third of infections were symptomatic, including half of infections with cycle threshold values <25. Infection with norovirus genotype GII.4 Sydney was the strongest predictor of symptomatic infection in adjusted analyses, as was older age and higher viral load. Childcare attendance, breastfeeding, mother's secretor status, and prior infections were not predictive of symptom status. This study highlights fundamental characteristics of norovirus epidemiology in early life with implications for understanding the full natural history of the disease, disease transmission and prevention approaches.

Abstract Background Respiratory syncytial virus (RSV) caused approximately 100,000-160,000 hospitalizations annually in adults aged ≥60 years in the United States (US) before RSV vaccine introduction. In 2023, two vaccines were recommended for prevention of severe RSV disease in adults aged ≥60 years using shared clinical decision making. In 2024, a third product was licensed, and all three available vaccines were recommended for all adults aged ≥75 years and for adults aged 60-74 years at increased risk of severe RSV disease. We assessed post-licensure vaccine effectiveness (VE) to inform future recommendations and public communications. Methods VISION is a multi-site electronic health record-based study including &amp;gt;200 hospitals in the US. Adults aged ≥60 years hospitalized with RSV-like illness and tested for RSV were included. Cases had a positive molecular or antigen RSV test; controls had a negative molecular RSV test. Critical illness included admission to the intensive care unit or in-hospital death. VE against hospitalization and critical illness was calculated using a test negative design as (1-adjusted odds ratio) x 100% where the odds ratio compares odds of vaccination in cases and controls after adjusting for confounders. Results were stratified by time since RSV vaccination, age group, and immunocompromised status. Results Among 83,652 hospitalizations during October 2023-March 2024 and October 2024-March 2025, VE was 62% (95% CI: 56-67%, Table) against RSV-associated hospitalization, median 279 days after RSV vaccination. VE was 83% (95% CI: 73-89%) at 14-59 days after vaccination and 42% (95% CI: 30-53%) at least 1 year after vaccination (median 429 days). VE against RSV-associated critical illness was 69% (95% CI: 55-78%), median 277 days after vaccination. VE was similar by age group and among those with and without immunocompromising conditions. Conclusion RSV vaccines are effective at preventing severe RSV and have the potential to reduce the burden of RSV-associated hospitalizations among older adults, although waning protection was apparent during the second season after vaccination. Ongoing monitoring of RSV VE is warranted to ensure vaccines are working as expected, to understand duration of protection, and to inform policy decisions. Disclosures All Authors: No reported disclosures

BackgroundRespiratory syncytial virus (RSV) is the leading cause of hospitalization among US infants. The 2024-2025 season was the first full season with widely available RSV prevention products, (nirsevimab and maternal RSV vaccination) recommended for all infants aged < 8 months. To assess the impact of these products on RSV-associated hospitalizations, we compared RSV-associated hospitalization rates in infants aged < 6 months from 2017-2020 to 2024-2025.Table 1.Incidence rates of RSV-associated hospitalizations per 1,000 infants by site among infants <6 months of age, New Vaccine Surveillance Network, October-March 2017-2020 and 2024-2025 (N=1,299)Figure 1.Incidence rates of RSV-associated hospitalizations per 1,000 infants by site among infants <6 months of age, New Vaccine Surveillance Network, October-March 2017-2020 and 2024-2025 (N=1,299)MethodsInfants < 6 months of age hospitalized with acute respiratory illness (ARI) were systematically enrolled at 7 US medical centers. Nasal swabs were tested for RSV by reverse transcription polymerase chain reaction. RSV circulation was determined by the percent of RSV positives among all enrolled children from September-March 2024-2025. RSV-associated hospitalizations per 1,000 infants were calculated by site during October-March 2017-2020 and 2024-2025 using US census population denominators. 95% confidence intervals (CI) were estimated by bootstrap percentiles based on 1,000 bootstrap samples. Rates were adjusted for enrollment rates, surveillance days per week, test sensitivity, and hospital market share. The relative rate reduction (RRR) was calculated as (1 – rate ratio)*100%.Figure 2.Respiratory syncytial virus (RSV) circulation by site, New Vaccine Surveillance Network, September-March 2024-2025ResultsAmong 1,299 infants aged < 6 months, RSV-associated hospitalization rates decreased from 18.5 (95% CI 17.6 - 19.4) in 2017-2020 to 11.5 (95% CI 10.0 - 13.2) in 2024-2025, a 38% reduction (RR 0.62, 95% CI 0.54 - 0.72). The magnitude of reduction varied by site, ranging from 16% in Houston, TX (RR 0.84, 95% CI 0.70 - 1.01) to 75% in Rochester, NY (RR 0.25, 95% CI 0.13 - 0.37). Kansas City, MO (RR 0.34 95% CI 0.22 - 0.48), Pittsburgh, PA (RR 0.44, 95% CI 0.30 - 0.58), and Cincinnati, OH (RR 0.46, 95% CI 0.27 - 0.68) also had greater than 50% reductions. RSV circulation varied, beginning in September in Houston, TX and October/November in all other sites.ConclusionRSV-associated hospitalizations decreased 38% among infants < 6 months of age, with reductions varying by location. The magnitude of impact was reduced in sites with earlier RSV season onset, highlighting the importance of timing local product uptake relative to the RSV season in optimizing reduction of RSV-associated hospitalizations across the US.DisclosuresAll Authors: No reported disclosures

Abstract Background In February 2025, pediatricians alerted the Alaska Department of Health to a possible increase in cases of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). ARF/RHD are immune-mediated sequelae of group A Streptococcus (GAS) infections. ARF primarily affects school-aged children and can progress to RHD without appropriate antibiotic treatment and prophylaxis. RHD is characterized by damage to heart valves and can result in death. Early diagnosis, appropriate antibiotic treatment, and prophylaxis for people with ARF/RHD reduce the risk of ARF recurrence and RHD progression.Table 1:Demographic characteristics of patients with ARF and RHD included in medical records review, Alaska, Jan 2022–Feb 2025. (N=52)Table 2.Incidence of ARF/RHD among ages 3-17 years from medical records review, Alaska, Jan 2022–Feb 2025. Methods We calculated ARF/RHD incidence among children aged 3–17 years living in Alaska during January 2022–February 2025 using data reported by healthcare systems in response to a statewide call for cases. We conducted medical chart reviews to collect information on presenting signs and symptoms, prior GAS infections, clinical management, and outcomes. We also conducted a secondary data analysis of the Indian Health Service’s (IHS) National Patient Information Reporting System to calculate incidence of ARF/RHD during 2014–2023 among Alaska Native children aged 3–17 who received care within the Tribal Health System.Figure 1.Indian Health Service National Patient Information Reporting System trends in reported incidence of new ARF and RHD among AI/AN children aged 3–17 years, Alaska, 2014–2023Figure 2.Indian Health Service’s National Patient Information Reporting System reported average ARF incidence (3–17 years) among AI/AN people by region, Alaska, 2014–2023 Results ARF and RHD incidence among children aged 3–17 increased from 3.8 and 1.9 per 100,000 persons per year in 2022 to 5.3 and 5.3 per 100,000 persons per year, respectively, in 2024. Incidence was highest in the northern (ARF: 33.5; RHD: 33.5) and southwestern (ARF: 23.0; RHD: 41.4) regions of Alaska and among children who were Alaska Native (ARF: 11.1; RHD: 11.1) or Native Hawaiian/Pacific Islander (ARF: 27.3; RHD: 16.4). Analysis of IHS data found the average annual incidences of ARF/RHD during 2014–2023 among Alaska Native children aged 3–17 were 6.2 per 100,000 persons and 8.5 per 100,000 persons, respectively. Conclusion ARF/RHD incidence in Alaska is higher than the rest of the United States, particularly among Alaska Native and Native Hawaiian/Pacific Islander people. The observed recent increases may be linked to factors such as a rise in GAS infections. Potential opportunities to improve early diagnosis and clinical management of GAS infections and sequelae can inform public health recommendations and clinical guidance. Disclosures All Authors: No reported disclosures

Violence-related injuries are a serious cause of morbidity among children and youth. This study used timely emergency department (ED) visit data from 12 jurisdictions participating in CDC's Advancing Violence Epidemiology in Real-Time (AVERT) program to examine trends in violence-related ED visits among children and youth. ED visits involving youth violence, suspected child abuse and neglect, and sexual violence among children and youth during January 2022-April 2025 from the AVERT program were examined by individual-level and county-level characteristics. During the study period, among the violence-related ED visits examined, visit rates were highest for youth violence (860 per 100 000 visits among adolescents aged 10-17 years), followed by suspected child abuse and neglect (401 per 100 000 visits among persons aged 0-17 years) and sexual violence (221 per 100 000 visits among persons aged 0-17 years). Seasonally, youth violence visit rates typically increased during spring and fall; suspected child abuse and neglect and sexual violence visit rates peaked in summer. Child abuse and neglect and sexual violence visit rates were higher among adolescents aged 10-17 years compared with children aged 0-9 years, and highest among females, whereas youth violence rates were highest among males. Across all forms of violence, visit rates were higher among non-Hispanic Black or American Indian/Alaska Native persons compared with Asian persons, and among those living in urban versus rural counties. Understanding the types of violence-related injuries that children and youth experience, when violence is most likely to occur, and who is at greatest risk is critical for informing prevention.

Although numerous US jurisdictions restrict the sale of flavored tobacco products, the comprehensiveness of policies varies greatly. This study assesses differences in tobacco product use and flavored tobacco use among youth and young adults residing in areas with and without flavored tobacco restriction policies other than federal-level restrictions, by strength of policy. Cross-sectional data come from Wave 1 (October 2022) of the nationally representative Tobacco Epidemic Evaluation Network (TEEN+) Study of US youth and young adults (N = 10255). Respondents' latitude and longitude were used to assign flavor policy coverage as no policy (80.9%), partial policy (major exemptions, 11.1%), or strong policy (minor/no exemptions, 8.0%). Policy coverage varied by several demographic characteristics, including race and ethnicity (P < .001), household smoking (P < .01), and household e-cigarette exposure (P < .01). Compared with living in an area with no flavor policy, a lower prevalence of any tobacco product use (aPR = 0.76, P < .001) and a lower prevalence of any flavored tobacco product use (aPR = 0.70, P < .001) were observed for those covered by strong flavor policies in multivariable Poisson regressions, adjusting for other individual- and state-level covariates. Living in an area with a partial flavor restriction was not significantly associated with different prevalence of either outcome in adjusted models compared with living in an area with no flavor policy. However, currently only 1 in 12 young people are protected by strong flavored tobacco sales restrictions, with notable gaps by race and ethnicity. Strong flavored tobacco sales restrictions that protect everyone, everywhere might help accelerate declines in youth and young adult tobacco use.

IntroductionThere is high interest in long-acting injectable antiretroviral therapy (LAI-ART) among people with HIV (PWH), with many conveniences for uptake and persistence. However, both patients and clinicians have expressed important barriers to effective implementation, including concerns about frequent clinic visits and strain on clinic resources. Administration of LAI-ART by a trained layperson injector (such as family, friend or partner of the patient) can help mitigate some of these patient-identified and clinician-identified barriers. Alternative LAI-ART delivery methods have the potential to increase the PWH and layperson injector’s confidence, empowerment, convenience, privacy and self-management skills and ultimately facilitate LAI-ART uptake and persistence.Methods and analysisINVITE-Home (innovative administration of long-acting injectables for HIV treatment enhancement at home) will support the expansion of LAI-ART in non-clinical settings by developing, implementing and evaluating a comprehensive, theory-informed training to support the administration of LAI-ART by a trained layperson injector. First, INVITE-Home will design and develop an innovative, theory-based layperson injector training to improve acceptability and uptake of LAI-ART in home-based settings, grounded in qualitative evaluation of training barriers and needs of PWH, layperson injectors and clinicians to develop the training. In Aim 2, INVITE-Home will enhance understanding of home-based LAI-ART using the training, by examining implementation and effectiveness of home-based LAI-ART injections.Ethics and disseminationThis study and its protocols have been approved by the University of California, San Francisco (UCSF) Institutional Review Board and the scientific staff of HIV Research Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, at the Centers for Disease Control and Prevention. Study staff will disseminate findings locally (eg, to partnering clinics, via the UCSF Center for AIDS Prevention Studies’ Community Engagement Core), statewide (eg, the California Department of Public Health’s Office of AIDS) and nationally at conferences related to HIV.Trial registration numberNCT06488846.