Center for Disease Dynamics, Economics & Policy

Youth aged 15-24 years are significantly impacted by tuberculosis globally. Their expanding social networks heighten exposure risks, potentially amplifying tuberculosis transmission, but their role in within-household transmission remains poorly understood. A household contact cohort study in Lima, Peru (2009-2012) enrolled individuals (>15 years) with incident tuberculosis (index patients) and their household contacts (HHCs), following them for 12 months. We evaluated whether the age of index patients and HHCs modified the risk of tuberculosis infection among HHCs. Study outcomes included: (1) prevalent tuberculosis infection among child contacts (<15 years) at enrollment and (2) incident tuberculosis infection among HHCs. Whole-genome sequencing of Mycobacterium tuberculosis (Mtb) isolates from index-HHC pairs assessed whether index patient age modified the likelihood of within-household transmission, defined as ≤12 single-nucleotide polymorphism differences. Child contacts of youth index patients had a lower risk of prevalent tuberculosis infection than those with adult index patients (aRR = 0.77; 95% CI: .67-.87). Among index-secondary patient pairs, 62% (26/42) of pairs with a youth index patient were genetically linked, compared to 72% (48/67) of pairs with an adult index patient (P = .3). Child and youth contacts had lower incident tuberculosis infection risk at 12-month follow-up compared to adult contacts (child vs adult: HR = 0.33; 95% CI: .28-.38; youth vs adult: HR = 0.61; 95% CI: .52-.71). Youth play a limited role in household tuberculosis transmission. Compared to adults, youth transmitted less TB as index patients and were less likely to be infected as HHCs. Research should explore youth social interactions and community-based transmission to inform targeted prevention strategies.

Despite consistent evidence of the relationship between alcohol use and cancer risk, awareness of the alcohol-cancer link remains low among American adults. Given the increasing prominence of social media as a health information source, this study systematically examined samples of alcohol-related Instagram and TikTok posts to identify mentions of the alcohol-cancer link and characterize post content. We collected public Instagram and TikTok posts made on or before May 12, 2024, via a hashtag-based search for posts tagged with #alcohol, #beer, #wine, #liquor, and #cocktail. Following an iterative codebook development process, two independent coders qualitatively reviewed random 2% (n = 1666) samples of Instagram posts and 20% (n = 725) samples of TikTok posts. Cohen's κ for each coding category ranged from 0.65 to 1.00 for Instagram posts and 0.61 to 1.00 for TikTok posts, while percent agreement for codes with low training sample prevalence ranged from 96.0% to 100% for both platforms. We examined posts identified as featuring intoxication or binge or high-intensity drinking, having been made by an influencer, featuring alcohol products, and targeting specific groups using inductive thematic content analysis. Across both platforms, only one post, a TikTok video, mentioned the relationship between alcohol use and increased cancer risk. Posts often positively depicted alcohol and commonly considered beverages containing large amounts of alcohol as single drinks. 48.6% of Instagram posts were made by commercial entities and 69.7% showed an alcohol product. 68.1% of TikTok posts were posted by influencers, 52.7% were comedic, and 24.7% referenced intoxication, binge, or high-intensity drinking. Cancer risk communication is largely absent among Instagram and TikTok posts, which often portray alcohol use in a positive light. Social media represents a critical, yet underutilized, channel for disseminating public health information about the alcohol-cancer link. Content analyses can inform strategic, audience-tailored messaging for improving public awareness.

Population viral loads measured by reverse transcription quantitative polymerase chain reaction (RT-qPCR) cycle threshold (Ct) values are an alternative to case counts and hospitalizations for tracking epidemic trends, but their strengths, limitations, and statistical power under various real-world conditions have not been explored. Here, we used SARS-CoV-2 RT-qPCR results from hospital testing in Massachusetts, USA, municipal testing in California, USA, and a combination of theory and simulation analysis to quantify biological and logistical factors impacting Ct-based epidemic nowcasting accuracy. We found that changes to peak viral load, viral growth and clearance rates, and sampling approach and delays all affect the relationship between growth rates and Ct values. We fitted generalized additive models to predict the growth rate and direction of SARS-CoV-2 incidence using time-varying Ct value distributions and assessed nowcasting accuracy over two-week windows. The model predicted epidemic growth rates and direction well from ideal synthetic data (growth rate root-mean-squared error (RMSE) of 0.0192; epidemic direction area under the receiver operating characteristic curve (AUC) of 0.910) but showed modest accuracy with real-world data (RMSE of 0.039-0.052; AUC of 0.72-0.80). Predictions were robust to testing regimes and sample sizes, and trimming outliers improved performance. Our results elucidate the possibilities and limitations of Ct value-based epidemic surveillance, highlighting where they may complement traditional incidence metrics.

The 2025 US National HIV/AIDS Strategy identifies intimate partner violence (IPV) as a key social determinant in the HIV response. Women with HIV (WHIV) face heightened IPV risk, especially during pregnancy. We evaluated the associations between reproductive stage, structural risk factors and past-year IPV among WHIV in the United States. We conducted a cross-sectional analysis using 2022-2025 baseline survey data from the HOPE prospective cohort of WHIV across 14 sites in nine US states/territories. The outcome was past-year experience of physical, sexual, or psychological IPV or reproductive coercion. Reproductive stage was categorized as nulliparous, postpartum, parous/nonpregnant, and pregnant. We used generalized estimating equations to estimate prevalence ratios for the association of each risk factor with IPV. We fit separate models for each risk factor, adjusting for age, race, education, income, marital status, and study region. We assessed the impact of nonresponse to IPV questions. Among 742 participants, 538 (79%) had complete data on past-year IPV. Over one in four WHIV (26.4%) had experienced past-year IPV. Pregnant women had four times the prevalence of reproductive coercion [(aPR = 4.0; 95% confidence interval (95% CI): 1.7-9.5] and 1.7 times (aPR = 1.7; 95% CI: 1.3-2.3) the prevalence of psychological IPV, compared to parous/nonpregnant women. Early sexual debut (aPR = 2.3; 95% CI:1.2-4.5), transactional sex (aPR = 2.1; 95% CI:1.3-3.4), drug use (aPR = 1.7; 95% CI:1.1-2.6), and adverse childhood experiences (aPR = 1.2; 95% CI:1.1-1.2) were associated with past-year IPV. IPV is prevalent among WHIV, especially during pregnancy. Policies should prioritize comprehensive contraceptive access and IPV screening to address the intersecting epidemics of IPV and HIV.

ABSTRACT The rapid genome-based diagnostic approach of long read sequencing coupled with neighbor typing offers the potential to improve empiric treatment of infection. However, this approach is still in development, and clinical validation is needed to support its use. In this study, we present an assessment of a neighbour typing method (RASE - resistance associated sequence elements) to predict lineage or sequence type (ST) and antimicrobial susceptibility in real time for Klebsiella pneumoniae sensu lato. We analysed the initial reads generated during the early phase of long read sequencing from pure culture (n=99), mock communities (n=20) and metagenomic samples (n=20). RASE accurately identified 69.7% and 70% of STs in pure culture and metagenomes, respectively, and identified the STs of the isolates representing the highest proportion in mock communities. Regarding antimicrobial susceptibility prediction, the probability of susceptibility increased to 72% (95% CI 63%-80%) across all tested antibiotics, when RASE predicted susceptibility, and decreased probability of susceptibility to 8.9% (95% CI 6.4%-9.6%) when was indicative of a resistant phenotype. Our study confirmed that genomic neighbor typing in K. pneumoniae sensu lato is capable of providing informative predictions of ST and antibiotic susceptibility in less than ten minutes (after the start of sequencing) with 200-500 reads. IMPORTANCE The growing burden of antimicrobial resistance is leading to high rates of mortality and morbidity worldwide. This situation has made the selection of empirical antibiotic therapy challenging, due to the risk of treatment failure and the overuse of last-resort antibiotics. The development of new sequencing technologies is helping to reduce the waiting time for a microbiological diagnosis, providing information in the early phase of bacterial infections, which could help improve clinical outcomes in a time of rising antimicrobial resistance. In this context, we assessed the performance of RASE (resistance associated sequence elements) in Klebsiella pneumoniae , an opportunistic pathogen frequently associated with nosocomial infections, which can rapidly acquire antibiotic resistance genes. Thus, in our study we provide insights that may aid in the validation of RASE for clinical use.

BackgroundPolitical determinants of cancer risk are largely unexplored, conceptually and empirically.MethodsObservational analysis of associations present in 2017-2021 between 5 state-level political metrics and 4 age-standardized cancer outcomes (regional and distant stage at diagnosis for breast, cervical, and colorectal cancer among screening-age adults and premature cancer mortality), overall and in standardized linear regression models adjusting for state-level poverty and medical uninsurance.ResultsIn fully adjusted models (adjusted for state-level poverty and state-level medical uninsurance variables: % working age adults [age 35-64] without medical insurance; number of years of state Medicaid expansion), each 1 SD shift toward a more liberal political ideology (measured by voting record) among elected officials in the US House of Representatives was associated with decreased risk of diagnosis with regional and distant breast and colorectal cancer (respectively: −0.76, 95% confidence interval [CI] = −1.26 to −0.25; −0.75; 95% CI = −1.5 to 0). Risk of premature cancer mortality likewise was lower, in the fully adjusted models, with each 1 SD shift toward more liberal scores for the state electoral college vote (−2.01, 95% CI = −3.68 to −0.33), the state liberalism policy index (−2.51, 95% CI = −4.48 to −0.54), and political ideology of elected officials in the US Senate (−1.93, 95% CI = −3.71 to −0.14).ConclusionOur state-level analyses suggest that political metrics are associated with preventable cancer outcomes. Efforts to reduce population burdens of cancer and inequities in these burdens could benefit from analyses of sociopolitical drivers of cancer risk across the cancer continuum.

Post-campaign coverage surveys estimate the proportion of previously unvaccinated children vaccinated during supplementary immunization activities (SIA) but cannot address whether susceptible children seronegative to measles and rubella viruses were vaccinated during the SIA. We conducted a cross-sectional serosurvey nested within the November 2020 measles-rubella SIA in Zambia, systematically sampling children aged 9 months to 5 years at 30 SIA sites in Choma and Ndola Districts. A questionnaire administered to caregivers collected the child’s demographic information and vaccination history. Dried blood spot specimens were collected from child participants and for Immunoglobulin-G antibodies to measles and rubella viruses by enzyme immunoassay. We used the expected vaccination probability by age derived from Demographic and Health Surveys to quantify the value of the immunization campaign, estimating the proportion of children who would not have otherwise received routine MR doses. Among children enrolled with MR vaccination data (N = 2,364), 2,214 (94%) reported at least one routine MR dose before the SIA. We estimate 5.0% [95%CI, 4.2-5.9%] (n = 118/2364) of children would not have otherwise received routine MR dose 1 without the SIA and 23.4% [95%CI, 21.7-25.1] (n = 553/2364) would not have otherwise received routine MR dose 2. Thus, 1 in 3.5 doses were given to an MR un- or under-vaccinated child who may not have received that dose in the absence of an SIA. Eighty-six percent and 90% of children were measles and rubella seropositive before vaccination during the SIA. Thirty-six percent of children with no prior routine MR dose were measles seropositive, while nine percent of children with two prior routine MR doses were measles seronegative. Although children vaccinated during this SIA were highly likely to have previously received routine vaccinations, the SIA reached a considerable number of susceptible children. Monitoring SIA effectiveness and efficiency through standardized metrics and formats is critical for impactful vaccine delivery strategies.

Abstract IntroductionChildren experience elevated risks of developing and dying from tuberculosis (TB). We estimated the additional pediatric TB cases and deaths that could occur over 2025-2034 if programmes supported by United States bilateral health aid and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) are discontinued.MethodsWe collated data on funding sources for TB and HIV programs in low- and middle-income countries and constructed scenarios representing reductions in health aid from 2025. Using calibrated transmission-dynamic models for 130 countries, we projected the discontinuation of TB and HIV treatment services under several funding reduction scenarios, and how this would affect pediatric TB exposure and treatment access. We projected pediatric TB incidence and mortality over 2025-2034 to calculate the impact of funding reductions.ResultsCompared to maintenance of pre-2025 service levels, withdrawal of services currently supported by US bilateral health aid was projected to result in an additional 2.5 million (95% uncertainty interval: 1.8–3.3) pediatric TB cases and 340,000 (240,000–460,000) deaths over 2025-2034. Withdrawal of US support to the Global Fund and reduction in non-US contributions was projected to result in an additional million 8.9 (6.9–11.5) pediatric TB cases and 1.5 million (1.1–2.0) deaths, more than double the number expected with continued service levels. Impacts were greatest in Sub-Saharan Africa and South-East Asia. Restoration of services in 2026 led to a substantially smaller number of additional deaths.FindingsWithout actions to restore discontinued services, cuts to health aid for TB and HIV programs could result in large numbers of childhood TB deaths over the next decade.