The New Jersey Department of Health (NJDOH) is a governmental agency of the U.S. state of New Jersey. New Jersey's State Board of Health was established in 1877. Its administrative functions were vested in the Department of Health, which was created in 1947. In 1996, the latter was renamed the Department of Health and Senior Services (DHSS). In 2012, senior services programs moved back into the Department of Human Services, and DHSS again became the Department of Health.
Objectives To identify stakeholder perceived challenges and facilitators for implementing a clean fuel and clean stove intervention to reduce household air pollution and hypertension in Lagos, Nigeria.Design Qualitative study guided by the Exploration and Preparation phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, using focus group discussions and in-depth semi-structured interviews with inductive and deductive thematic analysis.Setting Peri-urban communities across the five administrative divisions of Lagos State, Nigeria.Participants 128 stakeholders from 32 communities, including community, religious, market and youth leaders, primary healthcare staff, and household decision makers. Approximately half were female.Interventions This was a pre-implementation needs assessment that included demonstrations of the clean stove and fuel.Primary and secondary outcome measures Thematic domains describing barriers and enablers to adoption and implementation, mapped to EPIS inner, outer, and bridging factors.Results Stakeholders reported barriers that included stove stacking, upfront stove cost, concerns about long-term fuel price and availability, equipment durability and maintenance, safety, mistrust of new technology, and uncertainty about stove performance for dishes requiring high heat and long cooking times. Reported facilitators included payment flexibility and subsidies, opportunities to test the stove, perceived benefits of cleaner and faster cooking with less soot, endorsement by community leaders, and interest in local retail and distribution to improve access.Conclusions Implementation planning for clean fuel and clean stove programmes should address affordability, reliable fuel supply chains, durability and service, culturally relevant cooking needs, and trust building through community leadership. These findings inform adaptation strategies for scale-up in similar low-resource settings.Trial registration number NCT05048147.
BACKGROUND:Hepatocellular carcinoma (HCC) risk is elevated among people with human immunodeficiency virus (HIV) (PWH), but survival disparities are poorly understood. METHODS:We used data from the HIV/AIDS Cancer Match Study, a U.S. population-based linkage of 12 HIV and cancer registries during 2001-2019. Multivariable-adjusted Cox regression was used to estimate adjusted hazard ratios (aHRs) for HIV and HCC-specific and all-cause mortality among people with HCC, and to estimate aHRs for factors associated with HCC-specific and all-cause mortality among PWH. RESULTS:A total of 71 516 cases of HCC including 1610 PWH occurred during 2001-2019. Compared to people with HCC without HIV, a higher proportion of PWH were men, younger at time of cancer diagnosis, and were Black or Hispanic. Overall, 1279 deaths occurred among PWH (62.5% of deaths from HCC). HIV was associated with 34% higher all-cause mortality (aHR 1.34; 95% confidence interval, 1.27-1.41), and slightly increased HCC-specific mortality (aHR 1.08; 95% confidence interval, 1.01-1.16). Male sex, older age at HCC diagnosis, and nonreceipt of cancer treatment modalities were associated with increased all-cause and HCC-specific mortality among PWH. Increased HCC-specific mortality was also observed among men who have sex with men, compared to people who inject drugs. All-cause and HCC-specific mortality declined across calendar periods from 2001-2003 to 2016-2019 (Ptrends & .0002 and .06, respectively). CONCLUSIONS:HIV is associated with 34% higher all-cause and 8% higher HCC-specific mortality among PWH with HCC compared to those without HIV. As PWH are now living longer, and are at higher risk of HCC, research should prioritize opportunities for HCC prevention, screening, diagnosis, and treatment.
Congenital cytomegalovirus (cCMV) is the most common infectious cause of birth defects and non-genetic hearing loss in U.S. children. Variations in cCMV screening practices and the absence of national cCMV surveillance in the U.S. hinders assessment of disparities in disease burden, clinical care, and intervention. We describe clinical characteristics of neonates with cCMV identified through a novel surveillance program.Table 1.Clinical signs, neuroimaging, and treatment among neonates with congenital cytomegalovirus disease or confirmed infection status — Surveillance for Emerging Threats to Pregnant People and Infants Network 2014–2023 (N=387 neonates)1 Some neonates classified as having cCMV infection at birth may go on to develop signs and symptoms later (e.g., sensorineural hearing loss, cerebral palsy) which would move them to a cCMV disease classification. Follow up is ongoing, and these results are preliminary. Additionally, 60% of infection cases came from Minnesota where a universal screening program is in place.2Reported in the medical record or a reported head circumference <3 standard deviations below the mean for age and sex using INTEGROWTH-21st standards, ICD-10-CM code of Q02 or mention of microcephaly in the medical record.3Malformation of cortical development includes cortical dysplasia, lissencephaly, pachygyria, polymicrogyria, or schizencephaly.4Intraventricular hemorrhage and findings reported as directly related to intraventricular hemorrhage were not included.Figure 1.Council for State and Territorial Epidemiologist Standardized Case Definition for Congenital Cytomegalovirus (cCMV) Six states (Illinois, Iowa, Minnesota, New Jersey, New York state [excluding New York City], and Utah) ascertained neonates with cCMV through jurisdiction-specific screening practices (universal [n=1], hearing-targeted [n=3], high-risk [n=1], diagnostic codes [n=1], and clinical report [n=2]), including births from 2023 (5 states) or 2014 to 2023 (1 state). Case classification followed the 2023 Council of State and Territorial Epidemiologists surveillance case definition (Figure 1). Data were collected through vital statistics, laboratory reports, and birth hospitalization medical records. Among 387 neonates with completed medical record abstraction, 73% were classified as confirmed cCMV infection, 28% confirmed cCMV disease, and 2% probable cCMV disease (Table 1). The most commonly reported signs among neonates with cCMV disease were microcephaly (62%) and petechia/purpura (29%), and the most common brain abnormalities among those with imaging (n=104) were intracranial calcifications (26%) and leukomalacia (21%). Of infants with cCMV infection, 25% had other signs reported not within the disease case criteria (e.g., small-for-gestational-age, brain cysts). Overall, 22% (87/387) were reported to have started treatment with antivirals within the first 14 days of life, including 26 with cCMV infection. These preliminary surveillance data demonstrate the feasibility of conducting cCMV surveillance. These findings should be interpreted with caution given the likelihood of under-ascertaining those with infection or with cCMV-associated signs not in the screening criteria. Preliminary findings are informing ongoing state efforts to improve surveillance and inform outreach to providers and caregivers. Continued surveillance and longitudinal data collection will provide more information on disease burden. Sarah B. Mulkey, MD, PhD, Pfizer: Advisor/Consultant
Abstract Tuberculosis screening is not mandatory for prospective tissue donors. In 2021 and 2023, two different bone allograft products caused nationwide tuberculosis outbreaks. We assessed the morbidity and mortality of the second outbreak and reviewed donor and tissue screening to identify deficiencies. Thirty-six people residing in nine states received the product during spinal and dental procedures. Twenty-seven recipients had tuberculosis infection, 11 had microbiologic or imaging evidence of tuberculosis disease, and two died from tuberculosis within 12 months of outbreak detection. Another recipient died from tuberculosis nearly 3 years after product implantation. The bone donor died of pneumonia and septic shock. Polymerase chain reaction testing of the product before and after distribution did not detect Mycobacterium tuberculosis . Mycobacterial culture was not performed until after outbreak detection, when M. tuberculosis was isolated from 2 of 6 unused product units. This outbreak demonstrates persistent gaps in tissue transplant safety. Appropriate selection of donors and mycobacterial culture of donated tissues could reduce but not eliminate the risk of M. tuberculosis transmission. Therefore, it is important that clinicians monitor tissue recipients and promptly report adverse events to tissue establishments and health authorities.
BACKGROUND:Reports of ceftriaxone serious adverse events (SAEs), including deaths, from multiple jurisdictions during December 2024-January 2025 prompted a nationwide investigation to evaluate product safety, characterize SAEs, and assess for changes in baseline adverse event occurrence via national databases. METHODS:In February 2025, CDC issued a national call for cases, defined as SAEs involving death or CPR within six hours of ceftriaxone injection, not otherwise explained and occurring in non-ICU settings during September 2024-August 2025. Epidemiologic and clinical data were collected by health departments and reported to CDC. Laboratory testing of ceftriaxone and lidocaine diluent was performed at FDA. Temporal trends in adverse events (2016-2019 vs 2020-2024) were assessed via Medicare claims and National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance System analyses. RESULTS:Among 31 cases identified from 27 healthcare facilities (65% outpatient) across 18 states during September 2024-August 2025, all involving death or CPR, 12 (39%) persons died, 23 (74%) had anaphylaxis-type presentations (65% without skin/mucosal involvement), 21 (68%) had previous ceftriaxone exposure, and 24 (77%) had cardiac comorbidities. Median age was 67 years (IQR: 60-81). Antihypertensive use was common (n=19/28, 68%). Product testing revealed no evidence of tampering, adulteration, endotoxin, or purity/potency issues. National adverse event trends were stable across 2016-2019 and 2020-2024. CONCLUSIONS:SAEs, including deaths, can occur after ceftriaxone receipt. Product testing and trend analyses did not identify evidence of a new safety issue. This investigation highlights the need for ongoing vigilance for ceftriaxone SAEs and reporting to FDA MedWatch.
