This study describes the contextual factors and scientific data associated with fentanyl-related deaths among individuals aged 0-17 years in North Carolina. Using information from the North Carolina Medical Examiner System from 2015 to 2024, 138 pediatric fentanyl deaths were identified. Manually abstracted scene information, toxicology results, and pathological findings allowed for a rarely examined in-depth analysis of circumstances surrounding these deaths. Children less than 2 years (n = 33, 1.38 per 100 000) and adolescents aged 15-17 years (n = 80, 1.96 per 100 000) experienced a fentanyl-related death rate higher than the statewide pediatric fentanyl-related death rate of 0.60 per 100 000 residents. Among children less than 2 years, 78.8% of overdose onset occurred in the decedent's primary residence, and drugs or paraphernalia were present at the scene in 51.5% of cases. Co-sleeping was documented in 60.6% of deaths, with 80.0% occurring in adult beds. Postmortem blood concentrations of fentanyl among children less than two years ranged from less than 0.50 to 280 ng/mL (mean 27.0 ng/mL, median 17 ng/mL). Among adolescents, 62.5% of overdose onset occurred in the decedent's primary residence, followed by a friend's residence (13.8%). History of substance use was documented in 82.5% of cases and drugs or paraphernalia were present in 67.5% of cases. Blood concentrations of fentanyl among adolescents ranged from less than 1.0 to 330 ng/mL (mean 21.7 ng/mL, median 11.0 ng/mL). Scene investigation and documentation allow for the recognition of behavioral trends, which can be targeted for age-specific overdose prevention strategies. Among decedents less than 2 years, notable trends included children co-sleeping in adult beds with access to drugs and drug waste and/or prolonged periods without supervision. Among older adolescents, several cases involved suspected counterfeit pharmaceuticals and/or periods of non-contact with primary caregivers. Improved workflows for pediatric medicolegal death investigation and electronic reporting strategies are already underway.
BACKGROUND:Older individuals (≥65 years) are at greatest risk of severe influenza requiring hospitalization. Since 2009, influenza-associated hospitalization rates during A(H1N1)pdm09-predominant influenza seasons have been lower than during A(H3N2) -predominant seasons. \. METHODS:Using laboratory-confirmed influenza hospitalization rates from U.S. population-based surveillance, we investigated the relative A(H1N1)pdm09 to A(H3N2) hospitalization rate ratios by patient year of age and birth cohort from 2010 through 2025. RESULTS:Results suggest partial protection against A(H1N1)pdm09 hospitalizations relative to A(H3N2) hospitalizations among patients born before 1945 (pre-1945 birth cohorts), and among individuals born during 1994 through 2009. Impact of partial protection against A(H1N1)pdm09-associated hospitalizations has diminished over time among older adults, contributing to elevated influenza hospitalization rates during the 2024-2025 influenza season. CONCLUSIONS:Our findings suggest that influenza A hospitalization rates may increase during future influenza seasons when both influenza A(H3N2) and A(H1N1) viruses circulate or following the emergence of novel A(H1N1)pdm09-like viruses.
BACKGROUND:Health departments prioritize reproductive-aged women for syphilis partner services (PS) to prevent congenital syphilis (CS). We assessed trends in PS effectiveness among women. METHODS:We classified reported syphilis cases (all stages) between 2015 and 2022 from 8 US jurisdictions as nonpregnant women (NPW) older than 45 years ("non-reproductive-aged NPW," a group sometimes not assigned for PS), NPW aged between 15 and 45 years ("reproductive-aged NPW"), pregnant women without a CS outcome ("pregnant no CS"), and pregnant women with a CS outcome ("pregnant and CS"). We compared trends in the yearly proportion within each group who reported partners and whose partners were treated (preventatively or if infected, before or due to PS). RESULTS:During 2015-2022, annual counts of syphilis increased (non-reproductive-aged NPW, +151.5%; reproductive-aged NPW, +208.0%; pregnant no CS, +160.4%; pregnant and CS, +559.3%). Overall, 88% of women were assigned for PS, >90% of assigned cases were interviewed, and >94% of interviewed cases were treated. Across groups, the proportion interviewed naming ≥1 locatable partner was higher in 2015 compared with 2022 (non-reproductive-aged NPW, 53.3%-36.3%; reproductive-aged NPW, 68.6%-42.8%; pregnant no CS, 80.8%-65.0%; pregnant and CS, 73.6%-47.0%), and the proportion with ≥1 partner treated was higher (non-reproductive-aged NPW, 31.3%-21.7%; reproductive-aged NPW, 43.7%-24.9%; pregnant no CS, 53.0%-38.0%; pregnant and CS, 41.5%-23.4%). CONCLUSIONS:As syphilis increased, health departments reached most women with syphilis and assured treatment. A decreasing proportion of women reported locatable partners. Integration of PS with other strategies is needed to prevent reinfection and syphilis transmission in women.
Red blood cell transfusions can lead to iron overload (IO) in sickle cell disease (SCD). We aimed to determine the relationship between SCD patients with IO and SCD comorbidities. Iron chelation regimen for IO in SCD patients was also studied. A cohort of 245 SCD adult patients receiving care at the Medical University of South Carolina (MUSC) was studied. Information was obtained from medical records. Statistical analysis was performed to examine correlations and odds ratios with 95% confidence intervals. We identified 85 (34.7%) participants who met IO criteria. The results showed a significant as-sociation of IO with stroke (OR= 14.67, p= 0.0001), pulmonary hypertension (OR= 4.75, p= 0.0006), acute chest syndrome (OR= 2.46, p= 0.003), and deep vein thrombosis (OR= 1.84, p= 0.04). There was a strong correlation bet-ween liver iron concentration (LIC) and ferritin levels (r= 0.5148, p<0.0001). Liver enzymes correlated well with LIC and ferritin levels. Eighty-six percent of participants (74/85) were on chelation therapy, but only 19% of them achieved a good response to the treatment. One-third of SCD individuals developed IO, associated with several comorbidities. Comprehensive measures must include periodic determinations of LIC and ferritin, followed by appropriate chelation therapy to prevent organ damage.
BACKGROUND Individuals with chronic pain often turn to the health care system for treatment and pain management strategies, but barriers to health care access can make this difficult. METHODS We analyzed data from the 2018 and 2019 North Carolina Behavioral Risk Factor Surveillance System (NC BRFSS) surveys to understand whether coping mechanisms for chronic pain differed by specific health care barriers, sex, and race/ethnicity. We assessed 4 health care barriers: coverage barrier (no health insurance), provider barrier (no personal doctor/provider), cost barrier (not seeing a doctor in the past year due to cost), and checkup barrier (no checkup in the past 2 years). RESULTS Compared to individuals with no health care barriers, individuals with any health care barrier used coping mechanisms tied to the health care system (e.g., prescription drugs and non-medication pain therapies) less frequently. Differences were also observed by sex and race/ethnicity. Among individuals with or without barriers, men reported using alcohol and marijuana or other street drugs to cope more frequently than women, while women used prescription medications more frequently than men. Among individuals with at least one barrier, Black, non-Hispanic individuals reported using prescription drugs and non-medication pain therapies less frequently than White, non-Hispanic individuals. LIMITATIONS The response rate for the NC BRFSS surveys was low, though adjusted for by weighting. We were limited by the available categories for coping mechanisms, and we restricted race/ethnicity analyses to White, non-Hispanic and Black, non-Hispanic individuals. CONCLUSIONS Our findings indicate that differences in the use of prescription and non-prescription pain therapies by race/ethnicity for individuals with chronic pain may also be interconnected with health care access barriers.
