North Carolina Division of Public Health

Abstract Background Host-directed therapies (HDTs) are emerging as promising adjuncts to anti-tuberculosis treatment (ATT), aiming to improve early bacteriological clearance and reduce treatment failures. This network meta-analysis (NMA) evaluated the efficacy of various HDTs in achieving negative sputum conversion at 4 and 8 weeks, using standard ATT (isoniazid, rifampin, ethambutol, pyrazinamide) as the referenceGraphical AbstractGraphical abstract showing key findings.Risk of bias analysisRisk of bias Methods A systematic review identified randomized controlled trials (RCTs) comparing HDTs—Interleukin-2 (IL-2), Immunoxel, Metformin, Mycobacterium vaccae, Statins, V5 Immunitor, and Vitamin D—plus ATT versus ATT alone. A Bayesian random-effects NMA using a binomial likelihood with logit link estimated odds ratios (ORs) and 95% credible intervals (CrIs). A frequentist NMA was conducted for comparison. Outcomes were sputum conversion at 4 and 8 weeksCumulative rankogram of host directed therapies in TuberculosisRadiogram showing pictorial representation of various treatment armsGraph showing SUCRA scores of Host directed therapies in Tuberculosis managementGraph showing sucre scores of the various HDTs used in the studies analyzed. Results Twenty-eight RCTs (4,260 patients) were included. At 4 weeks, V5 Immunitor (OR 30.7; CrI 11.0–102), Immunoxel (OR 5.68; CrI 1.82–17.4), and Mycobacterium vaccae (OR 2.05; CrI 0.996–4.94) ranked highest. IL-2, Vitamin D, and Statins showed modest, non-significant effects; Metformin had lower efficacy (OR 0.716; CrI 0.137–3.69). At 8 weeks, V5 Immunitor remained top (OR 35.4; CrI 8.89–201), followed by Vitamin D and M. vaccae. Frequentist models confirmed large effects for V5 Immunitor and Immunoxel for sputum conversion to negative at 4 weeks. Heterogeneity was moderate. Conclusion V5 Immunitor and Immunoxel significantly improved early sputum conversion when added to ATT. Findings were consistent across Bayesian and frequentist models, supporting potential inclussion of HDTs in tuberculosis therapy. Disclosures All Authors: No reported disclosures

Orthopoxviruses can transmit via inhalation of virus-laden airborne particulates, with the initial infection triggered along the respiratory pathway. Understanding the flow physics of inhaled aerosols and droplets within the respiratory tract is crucial for improving transmission mitigation strategies and elucidating disease pathology. Here, we introduce an experimentally-validated physiological fluid dynamics model simulating inhaled onset of smallpox caused by the variola virus of Orthopoxvirus genus. Using high-fidelity Large Eddy Simulations, we modeled inhaled airflow and particulate motion within anatomical airway domains reconstructed from medical imaging. By integrating these simulations with viral concentration and individual immune factors, we estimated the critical exposure durations for infection onset to be between 1−19 hours, aligning with existing smallpox literature. To formalize the broader applicability of this framework, we extended our analysis to mpox virus, a circulating pathogen from the same genus. For mpox, the mechanophysiological computations indicate a typical critical exposure duration of 24−40 hours; however, this can vary significantly–from as short as 8 hours to as long as 127 hours–depending on virion concentration fluctuations within inhaled particulates, assuming happenstance of viral evolution. Predictably longer than the critical exposure durations for smallpox, the mpox findings still strongly suggest the possibility for airborne inhaled transmission during prolonged proximity.

This study examines how maternal-fetal medicine (MFM) physicians in the Southeastern United States define abortion care in the context of legal restrictions following the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization. We conducted qualitative, semistructured interviews with 35 MFM physicians in 10 Southeastern states between February and June 2023. We analyzed interviews using a descriptive qualitative approach and identified emergent themes through inductive coding. This analysis explores the emergent theme that increased legal penalties in state abortion restrictions post-Dobbs prompted many MFMs to more closely examine the definition of abortion care and its potential impact on patient care. Whether participants believed a given scenario involved abortion care differed among participants and depended on situational factors such as intended fetal status at the time of delivery, gestational duration, and type of intervention. Regardless of participants' personal convictions, many expressed uncertainty over the legal definition of abortion. With little legal clarity and significant potential consequences, provider willingness to uphold the standard of care depended on their level of risk tolerance, leading to discrepancies in care. These findings demonstrate that provider definitions of abortion are nuanced and varied in ways that cannot be adequately captured in legal language. While individual conceptualizations of abortion are irrelevant to medical best practices, abortion restrictions position providers and institutions as gatekeepers of access to essential medical care based on how they define abortion. Fearing legal repercussions, providers may feel compelled to limit care beyond the scope of the law, resulting in delayed, denied, or inappropriate care and violation of patient rights to informed consent and bodily autonomy.

Current trials toward an HIV cure involve combination strategies aimed at achieving durable antiretroviral treatment (ART)-free viral control or HIV elimination, many relying on analytical treatment interruptions (ATIs) to evaluate efficacy. Given the physical, psychosocial, and interpersonal risks associated with ATIs, it is critical to monitor participants' experiences so that support can be provided when needed. While qualitative approaches have been used in similar settings, we designed and implemented a series of short, closed-ended participant surveys in the University of California, San Francisco-amfAR trial, a single-arm multi-intervention HIV cure-related trial with an extended ATI. Surveys were administered at relevant trial timepoints to capture participants' (n = 10) perspectives and experiences. These included their understanding of the trial, motivations, expectations, perceived risks, benefits, and burdens of trial participation, as well as their perspectives on restarting ART and partner protections. We describe these data using descriptive statistics and summarize lessons learned from implementing quantitative surveys in this complex trial. Our data indicate that all respondents understood the scientific goals and requirements of participating in the trial. Most were motivated to help advance research but many expressed anxiety about participating. During the trial, respondents had limited side effects, discomfort, and trial burnout. Those who completed surveys at ART restart reported mixed (positive and negative) feelings and challenges (e.g., missed doses) when restarting ART. Participants offered various methods for partner protection during ATIs and at ART restart. Many respondents expressed future willingness to participate in a similar HIV cure trial. While the number of respondents was small, these findings are consistent with concerns identified in guidance regarding these types of trials as well as qualitative findings from earlier studies. Moreover, we demonstrated that it is feasible to implement quantitative evaluations of participants' experiences. Such approaches should be implemented in future HIV cure trials to optimize human-centered research implementation.

We report a patient in North Carolina, USA, with Heartland virus infection whose diagnosis was complicated by previous Ehrlichia chaffeensis infection. We identified E. ewingii-infected and Bourbon virus-infected tick pools at the patient's residence. Healthcare providers should consider testing for tickborne viruses if ehrlichiosis is suspected.

As the impact of the overdose crisis continues to worsen, some interventions are proving to be more impactful than others. This article provides insight on the history of harm reduction as it relates to the overdose crisis, how harm reduction strategies are saving lives in North Carolina, and the challenges that could hinder these efforts.

Despite increasing prevalence of hypertension in youth and high adult cardiovascular mortality rates, the long-term consequences of youth-onset hypertension remain unknown. This is due to limitations of prior research, such as small sample sizes, reliance on manual record review, and limited analytic methods, that did not address major biases. The Study of the Epidemiology of Pediatric Hypertension (SUPERHERO) is a multisite, retrospective registry of youth evaluated by subspecialists for hypertension disorders. Sites obtain harmonized electronic health record data using standardized biomedical informatics scripts validated with randomized manual record review. Inclusion criteria are index visit for International Classification of Diseases, 10th Revision (ICD-10) code–defined hypertension disorder on or after January 1, 2015, and age < 19 years. We exclude patients with ICD-10 code–defined pregnancy, kidney failure on dialysis, or kidney transplantation. Data include demographics, anthropomorphics, US Census Bureau tract, histories, blood pressure, ICD-10 codes, medications, laboratory and imaging results, and ambulatory blood pressure. SUPERHERO leverages expertise in epidemiology, statistics, clinical care, and biomedical informatics to create the largest and most diverse registry of youth with newly diagnosed hypertension disorders. SUPERHERO’s goals are to reduce CVD burden across the life course and establish gold-standard biomedical informatics methods for youth with hypertension disorders.

A quarter of a million North Carolinians admit to experienc¬ing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.

Abstract Phylogenetic investigations indicate that multiple monophyletic clades (separate or distinct groups in a phylogenetic sense) exist within Vibrio , which has led to the reclassification of some species into different genera. The genera covered in this chapter are ubiquitous in aquatic environments, primarily marine waters. Pertinent clinical histories (when known) should accompany specimens to alert the laboratory to include appropriate isolation media for the Vibrionaceae in their stool workup; this is especially important in areas where the isolation of Vibrio is infrequent. Direct microscopic detection of vibrios in stool is not routinely recommended, since it may not be possible to distinguish pathogenic vibrios from other members of the enteric microbiota. Reagents for the serodiagnosis of cholera are available only in specialized reference laboratories, but titration of acute‐ and convalescent‐phase sera in agglutination, vibriocidal, or antitoxin tests is considered reliable.