The Minnesota Department of Health (MDH) is the state health agency of the State of Minnesota in the United States. The department has four offices in Saint Paul and seven outside of the Twin Cities metropolitan area: Bemidji, Duluth, Fergus Falls, Mankato, Marshall, Rochester, and St. Cloud.The agency was established in 1977 after the abolition of the state board of health, which had existed since 1872.The agency is responsible for Minnesotans' public health, including disease control and prevention, environmental health, public policy, and regulation of health care providers. Additionally, it runs an immunization program and reports on the quality of clinical care in hospitals and clinics across the state.On September 15, 2021, Minnesota Department of Health announced the release of Docket, a free mobile application that enables consumer access to the Minnesota Immunization Information Connection (MIIC) system.
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD CAH) is an autosomal recessive genetic condition that results from pathogenic variants in the CYP21A2 gene. Noncarrier parents are found in a small percentage of cases, typically due to de novo variants. However, uniparental disomy (UPD) should also be considered. UPD is generally suspected when an individual with an autosomal recessive condition is found to be homozygous for a rare pathogenic variant and consanguinity has been ruled out. However, UPD in CYP21A2 may be hard to recognize because homozygous genotypes are not uncommon. We present the case of a 19-month-old male born preterm who presented to pediatric endocrinology after a positive newborn screen for CAH. He was small for gestational age, with a history of adrenal crisis and elevated 17-hydroxyprogesterone (17-OHP). Genetic testing revealed homozygosity for two common pathogenic CYP21A2 variants: c.293-13C >G and c.1360C >T (p.Pro454Ser), both variants were found in the heterozygous state in the mother while the father’s CYP21A2 molecular testing was negative. UPD testing was pursued and the results were consistent with the patient having maternal isodisomy of chromosome 6. In cases of patients with CAH due to homozygous CYP21A2 variants, suspicion for UPD may be increased if the child also presents with intrauterine growth restriction (IUGR), or transient neonatal diabetes (TNDM) mellitus, associated with maternal and paternal UPD of chromosome 6, respectively.
Bacillus anthracis is endemic in the United States causing periodic outbreaks in wildlife and domestic animals. Currently, human anthrax cases in the U.S. are rare but were common in the 1950s–1960s due to industrial work with imported B. anthracis-contaminated animal products. Multiple-locus variable-number tandem repeat analysis (MLVA) initially differentiated B. anthracis into 89 genotypes and two major clades. Recently, whole-genome sequencing (WGS) was implemented to differentiate B. anthracis which allows for higher resolution and can eliminate risk of homoplasy. To assess the molecular diversity of U.S.-established isolates, we performed MLVA and WGS on 81 B. anthracis isolates from domestic animals or soil. By MLVA, most isolates (n = 58, 72%) were in the Western North America (WNA)/A1.a cluster. Isolates were also observed in the Ames (A3.b), Vollum (A4), and Group B clusters. Using WGS, two major clades (A and B) and four clusters (WNA, Ames, Vollum, Group B) were identified. The four WGS clusters correlated with previously established MLVA clusters (A1a, A3b, A4, and B1, respectively). Further differentiation of the WNA cluster showed that isolates collected from the same state generally clustered together and more broadly by region (west, central, Texas). In the current study, we provide an update on the genetic diversity of domestically established B. anthracis strains using MLVA and WGS. WGS was able to provide additional differentiation, particularly within the WNA cluster, which can lend assistance in epidemiological investigations.
What is considered ‘evidence’ in maternal and child health (MCH) has major implications for which organizations and initiatives receive funding. Despite growing recognition of the importance of community-rooted work, state and jurisdictional MCH agencies, (Title V) operate from an evidence framework that typically prioritizes empirical research and large-scale evaluations over community-rooted evidence (CRE). This study sought to examine how CRE informs decision-making within Title V agencies, understand capacity-building needs of community-based organizations (CBOs), and explore strengthening relationships between CBOs and Title V. This qualitative study interviewed Title V and CBO staff to explore current CRE perceptions and funder/CBO relationships. 16 CBO and 11 Title V staff participated in compensated interviews from February to July 2024. Interviews were conducted, transcribed, coded, and analyzed using a thematic analysis approach. CBO interviewees stressed the need to reimagine misaligned funder and CBO relationships to be rooted in trust, allow CBOs agency to define metrics of success for their work, recognize the credibility of CRE including qualitative data and storytelling, and introduce more flexibility into funding opportunities and reporting structures. Title V respondents expressed capacity building needs around how to operationalize CRE in their work and decision-making practices, as well as build CBO capacity. Funders including Title V can support tailored, innovative, and community-driven solutions to MCH challenges through uplifting CRE in evidence frameworks, investing in trust-based relationships with CBOs, and supporting CBO capacity building. Recommendations for how Title V can operationalize CRE in their work are also provided. The findings of this study reinforce trends in the behavioral health, child welfare, and tribal health fields that have recognized the validity and importance of CRE in demonstrating an initiative’s impact, cultural appropriateness, and alignment with community preferences. State agencies, like Title V, can uplift and value CRE when considering the evidence informing funding decisions to create opportunities for state and federal investments in community-rooted solutions. This work also emphasizes the opportunity for Title V to reimagine relationships with funded CBOs in accordance with trust-based accountability principles to establish more symbiotic, collaborative, and innovative partnerships.
Importance National organizations recommend antiviral treatment for hospitalized children with influenza; however, use in this setting has recently declined. Studies of oseltamivir effectiveness in children are limited by misclassification bias, unknown symptom onset date, and incomplete capture of antiviral use prior to admission. Objective To assess the association between oseltamivir receipt and intensive care unit (ICU) admission and hospital length of stay (LOS) among pediatric influenza-associated hospitalizations. Design, Setting, and Participants This cohort study used data that were obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), which conducts US population-based surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 states. The study data include seasons 2014 to 2015 through 2022 to 2023, excluding 2020 to 2021. Participants included children aged younger than 18 years who were hospitalized with laboratory-confirmed influenza and for whom a respiratory symptom onset date was available. These data were analyzed from October 2024 through May 2026. Exposures Oseltamivir receipt as a time-dependent exposure. Main Outcome(s) and Measure(s) The primary outcome was time from symptom onset to ICU admission. Secondary outcome was time from admission to discharge (LOS). Adjusted Cox proportional hazard models (aHR) with oseltamivir receipt as a time-dependent exposure were used. Results After exclusions, 6044 influenza cases were included in the primary ICU analysis, of whom 4240 (70.2%) received oseltamivir, and 7103 cases were included in the secondary LOS analysis, of whom 5746 (80.9%) received oseltamivir. In the ICU analysis, the median (IQR) age was 3 (1-7) years, 3382 (56%) were male and 3721 (44%) were female, and 2937 (49%) had 1 or more medical comorbidity—the most common of which was asthma in 1547 children (26%). In adjusted models, compared with untreated children, oseltamivir treatment reduced the hazard of ICU admission (aHR, 0.69; 95% CI, 0.60-0.80) and shortened LOS (analyzed as hazard of hospital discharge; aHR, 1.13; 95% CI, 1.06-1.21). Conclusions and Relevance In this cohort of children hospitalized with influenza, oseltamivir treatment was significantly associated with a reduced risk of ICU admission by 31% and decreased hospital LOS. These findings demonstrate the benefits of oseltamivir receipt and support current national recommendations for oseltamivir treatment as soon as possible in children hospitalized with suspected or laboratory-confirmed influenza.
Background Many US children have congenital heart defects (CHD), yet data on their long-term outcomes have limitations. The Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG of KIDS (CHSTRONG KIDS) addresses these gaps by surveying caregivers of children with CHD identified through birth defect surveillance systems [BDSS]. Objectives To describe the CHSTRONG KIDS project design, characteristics of the eligible population, and the percentage not up-to-date on recommended cardiology care. Methods Children born 2006–2021 with CHD were identified using active, population-based BDSS in Atlanta, Georgia, Massachusetts, and Minnesota and linked to vital records. Caregivers of eligible (living) children with CHD were invited to complete surveys in 2024–2025. Characteristics were compared by site and response status using χ2 tests. We also estimated percentages of children in CHSTRONG KIDS who had not seen a cardiologist within the guideline-recommended timeframe for their specific defects. Results Among 7239 identified children with CHD, 6240 were eligible for survey recruitment. Of those,1841 (30%) had caregiver-reported survey data. Several characteristics, including CHD severity, birth year, and Trisomy 21 diagnosis, varied by site (p < 0.05). Survey response rates differed by site, CHD severity, maternal race, maternal education, and rurality (p < 0.05), prompting development of post-stratification weights. A weighted 21.6% were not up-to-date on their cardiology care. Conclusion With data on >7200 CHD cases and >1800 caregiver-reported surveys, CHSTRONG KIDS provides a population-based view of long-term outcomes among children with CHD. Notably, one in five were not up-to-date on their cardiology care and therefore may not be represented in clinical cohorts.
