BACKGROUND:Household transmission of respiratory viruses may drive community spread. Few recent studies have examined household respiratory syncytial virus (RSV) transmission in the United States. METHODS:We conducted a prospective community-based cohort study from 1 June 2022 to 31 May 2023. Participants had blood samples collected and completed nasal swabs and surveys at least weekly, irrespective of symptoms. We tested serum for RSV antibody, nasal swabs by quantitative reverse transcription polymerase chain reaction (RT-qPCR), and performed whole genome sequencing. We evaluated secondary RSV transmission and associated risk factors based on a log-linear Poisson regression model. RESULTS:RSV was detected among 310 (10%) participants within 200 (20%) households. Most (94%) index cases were symptomatic. We identified 37 cases of potential secondary transmission within 14 days of a distinct index case (10%, 95% confidence interval [CI]: 7%, 14%); median age of index and secondary cases were 6 (interquartile range [IQR]: 3-10) and 35 (7-41) years, respectively, with 89% (24/27) of index cases aged 6 months to 12 years. Factors associated with increased risk of RSV transmission included index case viral detection ≥1 week and contact age ≤12 years. Of 120 sequenced specimens, the main lineages represented were A.d.5.2 (n = 37) and A.d.1 (n = 30). Sequenced viruses from households with ≥2 RSV infections were similar when occurring within ≤14 days (mean pairwise difference 4 [range 0-13], n = 17 households), compared to those >14 days (137 [37-236], n = 2). CONCLUSIONS:Most RSV household transmission occurs from infants and young children to adults. Viral genome sequencing demonstrated that multiple household infections within a 14-day period are likely due to within-household transmission.
Importance:Since 2020, COVID-19 has dramatically impacted the US population and health care system. Reporting requirements, circulating variants, testing practices, and population immunity from vaccination and previous infections evolved as the COVID-19 pandemic progressed. Evidence-based public health policy and resource allocation decisions require current estimates of disease burden. Objective:To estimate the age group-specific burden of COVID-19-associated illnesses, outpatient visits, hospitalizations, and deaths in the US from October 2022 to September 2024. Design, Setting, and Participants:In this cross-sectional study, hierarchical Bayesian modeling, adjusting for underdetection of SARS-CoV-2 due to testing practices and test sensitivity, was applied to hospitalization data from the population-based COVID-19 Hospitalization Surveillance Network (COVID-NET) database, which includes 89 counties and jurisdictional equivalents in 12 states covering approximately 10% of the US population. Data from 94 363 participants from October 2022 to September 2023 (surveillance period, 2022-2023) and from 72 176 participants from October 2023 to September 2024 (surveillance period, 2023-2024) were included, and probabilistic mathematical multiplier models estimated counts of deaths, outpatient visits, and symptomatic illnesses incorporating literature and study-based multipliers. Data were modeled from April 2024 to September 2025. Exposures:COVID-NET patients with a laboratory-confirmed COVID-19-associated hospitalization, defined as a positive SARS-CoV-2 test result within 14 days before or during hospitalization. Main Outcomes and Measures:Estimated national counts with 95% uncertainty intervals (UIs) of outpatient visits, illnesses, hospitalizations, and deaths by age group. Results:In 2022-2023, there were an estimated 43.6 million (95% UI, 25.3-64.0 million) COVID-19-associated illnesses, 10.0 million (95% UI, 7.0-13.1 million) outpatient visits, 1.1 million (95% UI, 0.9-1.4 million) hospitalizations, and 101 300 (95% UI, 73 600-132 500) deaths. In 2023-2024, there were an estimated 33.0 million (95% UI, 20.2-49.0 million) COVID-19-associated illnesses, 7.7 million (95% UI, 5.5-9.9 million) outpatient visits, 879 100 (95% UI, 738 600-1 039 000) hospitalizations, and 100 800 (95% UI, 64 000-140 400) deaths. In 2023-2024, people 65 years and older comprised 17.7% of the total US population but accounted for 47.9% (95% UI, 27.1-66.9) of COVID-19-associated illnesses, 64.3% (95% UI, 53.1-73.4) of outpatient visits, 67.6% (95% UI, 65.9-69.2) of hospitalizations, and 81.2% (95% UI, 70.2-90.6) of deaths. Conclusions and Relevance:In this cross-sectional study, despite declining from the first to the second surveillance period, the COVID-19 burden continued to have a large impact in the US, particularly among adults 65 years and older, underscoring the ongoing importance of prevention measures.
This cohort study compares hepatitis B vaccination series completion by 18 months in infants who did vs did not receive a birth dose.
Despite growing interest in hearing impairment as a potentially modifiable risk factor for dementia, the association is poorly understood. This has implications for whether treating hearing impairment can prevent or delay onset of dementia, as causation is not the only explanation for the association. In this editorial, we highlight how biases in research studies might account for the reported associations. We suggest future research using different study designs and novel biomarkers to help us overcome methodological limitations. This may allow us to determine the strength of the causal pathways linking hearing impairment to dementia, ultimately informing prevention and treatment strategies.
BACKGROUND: Implementing evidence-based interventions for population-level benefit can be challenging in resource-limited primary care settings. Research is needed to identify, specify, and systematically study implementation strategies that address the multilevel, contextual influences on implementation in these settings. This study reviewed and compared the implementation strategies proposed by Research Projects (RPs) funded through the Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) initiative. ACCSIS research projects implemented multilevel interventions to increase colorectal cancer screening and follow-up among their local populations. METHODS: Participating AC`CSIS RPs provided structured information about activities proposed to facilitate the implementation of evidence-based interventions to increase colorectal cancer screening, follow-up, and referral across project phases (i.e., exploration, preparation, implementation, sustainment). Three implementation science experts reviewed and matched program data to implementation strategies and domains using the Expert Recommendations for Implementing Change (ERIC) classification. ACCSIS RP teams then reviewed and validated matched strategies. Analyses examined similarities and differences among implementation strategies used by each RP and tracked across the screening continuum. RESULTS: Seven ACCSIS RPs participated in this analysis. Collectively, they reported 89 unique activities that matched 68 ERIC implementation strategies (range: 3 to 17 per site). Several similarities were noted across RPs, such as: four RPs developed and distributed educational materials and three used external facilitation as an implementation strategy. Of the nine domains under which the ERIC strategies are classified, most strategies used by the ACCSIS RPs fell under the domain of using evaluative and iterative strategies (e.g., conducting a local need assessment), followed by training and education (e.g., provider education). All RPs used strategies focused on screening and six used strategies to ensure screening follow-up; only one RP used strategies to improve access to treatment. Most strategies were reported in the preparation and implementation phases. CONCLUSIONS: Systematically documenting and collating implementation strategies across ACCSIS RPs contributes to the evidence base of how multilevel interventions can be implemented to reduce the burden of colorectal cancer through screening and follow-up. Study findings can be used to guide real-world implementation efforts, including future scale-up and sustainment.
