Michigan Department of Health and Human Services

Through vaginal colonization, group B Streptococcus (GBS) causes severe outcomes including neonatal sepsis and meningitis. Although intrapartum antibiotic prophylaxis (IAP) has reduced neonatal disease rates, GBS can persist in the genitourinary tract even after antibiotic administration. To determine if IAP selects for genomic signatures that enhance GBS survival and persistence, we compared the isolates from individuals before (prenatal) and after (postpartum) IAP/childbirth. Among 34 of the paired strains from participants with persistent colonization, 31 (91.2%) clustered together in a core gene phylogeny, suggesting colonization with highly similar strains before and after IAP. A core-gene mutation analysis, however, identified mutations in 74% (n = 23) of these 31 postpartum genomes when each genome was compared to its respective prenatal genome from the same individuals. Several strains acquired mutations in the same genes, although two postpartum strains accounted for most of the mutations. These two strains were classified as mutators based on high mutation rates and mutations within DNA repair system genes. Changes in biofilm production were observed in a subset of postpartum strains, which is supported by the presence of point mutations in genes linked to survival and colonization. These findings suggest that exposures encountered during pregnancy and childbirth may select for mutations and phenotypes that promote adaptation and survival in vivo. Enhanced survival in the genitourinary tract can lead to persistent colonization, increasing the likelihood of invasive disease in subsequent pregnancies and in newborns (late-onset infections) following IAP cessation.IMPORTANCEGBS remains a major cause of neonatal sepsis, pneumonia, and meningitis despite the common use of IAP that aims to eradicate maternal colonization, the main risk factor for neonatal disease. Although IAP has reduced the incidence of early-onset neonatal infections, it has had no impact on late-onset infections in babies between 7 days and 3 months of age. Since colonization is intermittent and GBS has been shown to persist in the genitourinary tract despite antibiotic exposure, more research is needed to understand mechanisms of adaptation. By comparing the genomes of GBS strains recovered before (prenatal) and after (postpartum) IAP and childbirth, this study demonstrates how selective pressures shape GBS evolution, favoring traits that promote survival and persistence. Understanding adaptive traits is essential for improving diagnostics, refining prophylaxis strategies, and guiding the development of more effective prevention practices that can reduce the likelihood of GBS transmission to neonates.

Many adults with Long COVID experience adverse mental health outcomes, but the long-term persistence of these associations remains unclear. We examined the prospective associations of Long COVID with depressive and anxiety symptoms three years after initial infection. We used a population-based cohort of Michigan adults with PCR-confirmed COVID-19, excluding respondents with baseline symptoms (resulting analytic samples: n = 2,431 for depressive symptoms; n = 2,301 for anxiety symptoms). Long COVID was defined as symptoms lasting ≥ 90 days after initial infection, assessed at baseline (median 4.4 months post-infection). Depressive and anxiety symptoms were evaluated 1.5 years (follow-up 1) and 3 years (follow-up 2) after infection. We used modified Poisson regression models to estimate risk ratios (RR) for each outcome and multinomial logistic regression models to examine Long COVID and mental health outcomes measured across two follow-up periods. Long COVID was associated with higher risks of depressive symptoms (aRR:1.86, 95

CONTEXT:Immunization information systems (IIS) data can be used to routinely monitor immunization coverage to monitor geographical vaccination coverage. Analyses for smaller geographical areas are more sensitive to data quality errors and resident mobility, which may bias coverage estimates. Improving these estimates also contributes to health equity because certain small populations may face disproportionate health challenges. OBJECTIVE:To evaluate how data exchange with adjacent jurisdictions affects immunization coverage estimates in Michigan, Minnesota, and Wisconsin. DESIGN:Retrospective cohort study. SETTING PARTICIPANTS:Immunization data for Michigan, Minnesota, and Wisconsin residents from the Michigan Care Improvement Registry, Minnesota Immunization Information Connection, and Wisconsin Immunization Registry, respectively. MAIN OUTCOME MEASURES:Count of out-of-state immunizations; distribution of residents with at least 1 out-of-state immunization; change in routine childhood, adolescent, and adult influenza and COVID-19 immunization coverage estimates. RESULTS:Despite a modest state-wide impact, analysis in all 3 jurisdictions revealed sizeable effects at the county level, especially in immunization coverage estimates along state borders. In Michigan, 0.3% of IIS residents had received at least 1 vaccination in Wisconsin; including these records led to increases in routine childhood coverage estimates as high as 40% in 1 county. This was also true for Minnesota and Wisconsin, with 8.1% and 3.8% of the population having a known out-of-state vaccine, respectively, driving up routine childhood coverage estimates by 60% or more in some counties. CONCLUSIONS:IIS-to-IIS data exchange has improved capture of certain populations within Michigan, Minnesota, and Wisconsin. In all 3 jurisdictions, the impact of interjurisdictional data exchange was concentrated in border counties, suggesting that jurisdictions with mobile populations along their borders will gain the most from investing in this infrastructure.

Pregnant women with late latent or latent of unknown duration syphilis are recommended to receive three doses of benzathine penicillin G each 9 or fewer days apart; data on interval variations are limited. We found no significant difference in risk of congenital syphilis between 9-day and 6-8 day dosing intervals. Summary Among pregnant women with late latent or latent of unknown duration syphilis, there was no difference in risk of congenital syphilis between 9-day and 6-8 day maternal treatment dosing intervals. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This activity was reviewed by CDC and conducted consistent with applicable federal law and policy (45 C.F.R. part 46.102(l)(2), 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a). It was deemed public health surveillance and exempt from IRB. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes These data are collected under relevant provisions of the Public Health Service Act and are protected at CDC by an Assurance of Confidentiality (Section 308(d) of the Public Health Service Act, 42 U.S.C. 242 m(d))(), which prohibits use or disclosure of any identifiable or potentially identifiable information collected under the Assurance for purposes other than those set out in the Assurance. Requests for access will be considered on a case by case basis, and inquiries should be directed to setnet{at}cdc.gov. Centers for Disease Control and Prevention, https://ror.org/042twtr12, This study was performed as regular work of the Centers for Disease Control and Prevention (CDC) and is supported by the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases Cooperative Agreements (CDC-RFA-CK19-1904 and CDC-RFA-CK24-0002), Division of Birth Defects and Infant Disorders Cooperative Agreement (CDC-RFA-DD-23-0003), and through contractual mechanisms, including the Local Health Department Initiative to Chickasaw Health Consulting (200-2021-F-12655).