The Washington State Department of Health is a state agency of Washington. It is headquartered in Olympia, Washington. The agency was created by the state legislature in May 1989 after splitting from the Washington State Department of Social and Health Services.
Importance:Expanded screening and treatment options as part of national guidelines and statewide policy initiatives have the potential to eliminate hepatitis C virus (HCV). Objective:To describe trends in HCV screening, prevalence, treatment, and costs before and after Washington State's HCV elimination initiative. Design, Setting, and Participants:This case series is an observational analysis of retrospective claims data aggregated at the individual-month level. The dataset included individuals in the Washington State All Payers Claims Database between January 2017 and September 2022. Analyses were conducted from August to November 2025. Exposures:In July 2019, as part of a directive from the governor, the Washington State Department of Health released a comprehensive HCV elimination strategy. The plan included discounted and subscription-based payment models and removal of restrictive prior authorization and specialist consultation requirements. Main Outcomes and Measures:International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) and Current Procedural Terminology codes were used to identify HCV testing or screening, ICD-10 diagnosis codes were used for HCV infections, and the National Drug Codes were used for HCV direct-acting antiviral medications. An individual was considered to have newly diagnosed HCV at the earliest month in which they had an HCV test claim followed by 2 HCV diagnosis codes within the subsequent 12 months and no HCV diagnosis during the 6 months before the test month. Total health care costs per month were computed, excluding cost of HCV direct-acting antiviral medications. Interrupted time-series approaches computed trends over time using the second quarter (Q2) of 2019 as a reference time point. Results:More than 21 million unique individuals (mean [SD] age, 44 [26] years; 11 085 080 female [53%]) were included in the data extraction. The number of HCV tests per month was stable during the preinitiative and immediate postinitiative period. Beginning in 2020 Q3, screening increased significantly from the reference quarter by 10.5 additional tests per month per 1000 Washington enrollees (95% CI, 8.8 to 12.2 tests per month per 1000 enrollees; P < .001). Consistent with increased screening, the prevalence of chronic HCV cases increased through 2021, but declined by 0.4 cases per 1000 enrollees comparing 2019 Q2 to 2022 Q3 (95% CI, -0.6 to -0.2 cases per 1000 enrollees; P < .001). The proportion of newly diagnosed cases receiving any HCV treatment increased from 16.8% (634 of 3776 cases) in 2017 to 24.9% (472 of 1894 cases) in early 2021 (difference, 8.1 percentage points; 95% CI, 5.8 to 10.4 percentage points; P < .001), but slopes before and after 2019 Q2 were not significantly different. Costs per ever prevalent case decreased significantly by 2021 Q1 (-$520 per month compared with 2019 Q2; 95% CI, -$922 to -$124 per month; P = .01). Conclusions:In this longitudinal case series analysis of claims data, Washington State's elimination initiative, combined with revised national screening guidelines and improved treatment options, contributed to expansion of HCV screening and changes over time in the proportion of people identified and treated for HCV, as well as decreased overall care costs.
Drawing from an interdisciplinary synthesis of microbiology, chemistry, osteopathic medicine, psychology, environmental health, and regulatory policy, this commentary highlights the increasingly pertinent issue of pesticide residues in state-legal cannabis products and clinical implications for medical cannabis patients. This commentary uses peer-reviewed and gray literature along with state cannabis regulations to highlight the toxicological gap that pesticide action levels are not based on human health risk and are not cannabis-specific; instead, they are derived from analytical detection limits and noncannabis crop assumptions. Medical cannabis patients may also have a higher exposure risk than other people who use cannabis for adult-use (nonmedical) purposes. For example, medical patients may have complex medical co-morbidities and use cannabis products more frequently than those who use products for nonmedical purposes. Medical patients have expressed concern about pesticides and their increased risk in several settings (e.g., online, public testimony, clinical). Further research is warranted to better quantify vulnerable patient populations including risks of pesticide exposures for specific qualifying health conditions. Given the increased prevalence of cannabis use across the United States, it would be beneficial for health care providers to be equipped with this knowledge for their patients who use cannabis and feel comfortable recommending different products and safer routes of administration (e.g., noncombustible). To work toward health-based pesticide testing thresholds, prioritizing differential risks from route of administration, product type, and real-world dosing behaviors is essential. Policymakers aiming to adopt health-based pesticide testing criteria will benefit from supporting additional research to set these standards.
Importance:A long-acting monoclonal antibody (nirsevimab) for use in infants aged 7 months or younger and an antenatal respiratory syncytial virus (RSV) vaccine (RSVpreF) became available in Washington state in 2023. Objective:To estimate the combined population-level impact of nirsevimab and antenatal RSV vaccine on the relative rate of RSV-associated hospitalizations and emergency department (ED) visits among infants during the first 2 respiratory seasons of use. Design, Setting, and Participants:This difference-in-diferrences cohort study used data from the Washington state syndromic surveillance program on RSV-associated hospitalizations and ED visits among infants from July 1, 2022, to June 30, 2025. Exposure:Introduction of nirsevimab for infants and antenatal RSVpreF. Main Outcomes and Measures:A difference-in-differences analysis was conducted to estimate mean relative changes in the rate of RSV-associated hospitalizations and ED visits between the period before and the period after introduction of RSV prevention products for children aged 7 months or younger (treatment group) beyond that for children aged 8 to 24 months (comparison group) using negative binomial models. Relative changes were estimated separately for July 1, 2023, to June 30, 2024, and July 1, 2024, to June 30, 2025, vs July 1, 2022, to June 30, 2023. Results:During July 2022 to June 2025, there were 16 775 RSV-associated hospitalizations and ED visits among children aged 24 months or younger in Washington state (median age, 10 months [IQR, 4-19 months]; 9228 male [55%]). The median age increased from 9 months (IQR, 3-19 months) during 2022-2023 to 12 months (IQR, 6-21 months) during 2024-2025. During the first year of limited use of RSV prevention products (2023-2024), estimates did not indicate a significant decrease in the rate of RSV-associated hospitalizations and ED visits among children aged 7 months or younger beyond temporal trends also observed for children aged 8 to 24 months (ratio of relative rates, 0.92 [95% CI, 0.80-1.03]). In the second year of use (2024-2025), there was an estimated 43.0% (95% CI, 32.0%-52.1%) relative decrease in the rate of RSV-associated hospitalizations and ED visits among children aged 7 months or younger beyond that for children aged 8 to 24 months. Relative changes were similar across racial groups, except for Native Hawaiian or Other Pacific Islander children. The estimated impact in 2024-2025 was 1.77 times (95% CI, 1.17-2.66 times) higher for White vs Native Hawaiian or Other Pacific Islander children. Conclusions and Relevance:In this cohort study of children aged 24 months or younger, nirsevimab and antenatal RSVpreF vaccine were associated with a reduced burden of RSV-associated hospitalization and ED visits among infants aged 7 months or younger. Results support continued use of these products in the state. Increased coverage will likely be associated with additional decreases in severe disease burden, particularly among populations at increased risk.
Abstract Antimicrobial resistance (AMR) is a pressing global public health challenge. AMR is driven in part by the spread of antibiotic resistance genes (ARGs) through bacterial communities via mobile genetic elements. Influent wastewater is a promising sample type for monitoring AMR because it pools biological inputs shed by individuals across a population. However, untargeted sequencing approaches, such as metagenomic sequencing, often miss low-abundance targets such as clinically important ARGs. In this work, we develop a ligation-mediated PCR (LM-PCR) enrichment strategy that can directionally capture the genomic context surrounding an ARG using long-read sequencing. We applied this method to study the natural genomic context diversity of four clinically relevant ARGs (blaCTX-M, blaKPC, and blaOXA-48-like, and qnrS) across 13 wastewater treatment plants in Washington state, each sampled at two timepoints. Across all timepoints, LM-PCR identified distinct genomic context cluster families associated with each ARG, including seven for blaKPC, 11 for blaCTX-M, 24 for qnrS, and one for blaOXA-48-like. Notably, 11 of the 24 qnrS containing clusters were putatively novel, with no matches to existing sequences in public databases. Genomic contexts associated with blaCTX-M and blaKPC were comparatively conserved across clusters, whereas qnrS was associated with a more diverse set of genetic sequences. Together, these results demonstrate that LM-PCR can resolve low-abundance, ARG-associated genomic variation in complex wastewater samples and provide a scalable framework for tracking the dissemination of clinically relevant AMR determinants.
A patient-centered HIV care model (PCHCM) can improve antiretroviral treatment adherence and viral suppression outcomes. No studies have evaluated viral suppression among people with HIV (PWH) in carceral settings under this model. This study compares HIV virologic suppression among PWH in Washington state prisons under a PCHCM to all PWH in Washington between 2008 and 2019. We conducted three analyses of a retrospective cohort of 403 PWH in prison. Prison-wide annual viral suppression proportions among total HIV population and the HIV population tested each year were compared with Washington public health surveillance data. Average changes in viral suppression proportions at intake and release were summarized and tested for statistically significant differences. Prison-wide HIV viral suppression increased from 61.4% in 2008 to 86.0% in 2019, surpassing most annual statewide proportions. Viral suppression proportions among those with at least one yearly viral load test were even higher. Between 2015 and 2019, > 95% of incarcerated PWH achieved viral suppression. Average viral suppression proportions increased during incarceration from 59.1% at intake to 92.4% at release between 2008 and 2019 (p < 0.05). Prison populations can reach near universal viral suppression under a PCHCM, suggesting a higher threshold from which to judge the effectiveness of HIV carceral care.
