Morbidity and Mortality Weekly Report (MMWR)

Among adults receiving human immunodeficiency virus (HIV) care from 2011 to 2015, American Indians/Alaska Natives patients had high poverty levels (51%), depression (27%), HIV stigma (78%), and suboptimal sustained HIV viral suppression (64%).

In 2017, among 70,237 drug overdose deaths, 47,600 (67.8%) involved opioids, with increases across age groups, racial/ethnic groups, county urbanization levels, and in multiple states. From 2013 to 2017, synthetic opioids contributed to increases in drug overdose death rates in several states. From 2016 to 2017, synthetic opioid-involved overdose death rates increased 45.2%.

On June 12, 2018, the Michigan Department of Health and Human Services requested assistance from CDC to investigate risk factors for Salmonella infection linked to live backyard poultry originating at a mail-order hatchery in Michigan.

A U.S. citizen was bitten by a puppy while in India; rabies postexposure prophylaxis was not sought. The traveler developed rabies upon return to the United States and died during hospitalization.

In 2017, among 70,237 drug overdose deaths, 47,600 (67.8%) involved opioids, with increases across age groups, racial/ethnic groups, county urbanization levels, and in multiple states. From 2013 to 2017, synthetic opioids contributed to increases in drug overdose death rates in several states. From 2016 to 2017, synthetic opioid-involved overdose death rates increased 45.2%.

CDC evaluated a pilot HIV-related mortuary surveillance system in Nairobi, Kenya.

The percentage of emergency department visits for pain with an opioid given or prescribed for those aged

Parent-reported data from 2016 indicated that a higher percentage of children in lower-income households had ever received a diagnosis of a mental, behavioral, or developmental disorder and a lower percentage had seen a health care provider in the previous year, compared with children in higher-income households. Most children in lower-income households were in families receiving public assistance benefits.

During 2014-2016, blood collections increased and donor HIV prevalence decreased in seven of 14 countries, but systems to link HIV-positive and donors at high risk to testing and treatment are inadequate.

Importation of a rabid dog into the United States from Egypt, with documentation of rabies vaccination but no medical history, resulted in a six-state investigation and administration of rabies postexposure prophylaxis to multiple persons.

On September 17, 2018, the Texas Department of State Health Services received notification of Enterobacter cloacae and Citrobacter freundii bloodstream infections in three patients who had received injections or infusions of non-FDA-approved umbilical cord blood-derived stem cell products processed by Genetech, Inc., and distributed by Liveyon, LLC, for other than hematopoietic or immunologic reconstitution at an outpatient clinic on September 12.

During 2013-2015, total drug and opioid-involved overdose mortality rates for American Indians and Alaska Natives were 2.7 times higher than those of whites in Washington. Misclassification of American Indians and Alaska Natives race in death certificates underestimated overdose mortality among American Indians and Alaska Natives in Washington by approximately 40%.

Despite recommendations, most U.S.-bound Congolese refugees with splenomegaly did not have documented receipt of primaquine after resettlement. Most patients were clustered within families. Approximately 50% of patients with available medical records had persistent splenomegaly >6 months after arrival; 63% of patients with splenomegaly had a hematologic abnormality.

During 2015-2017, the proportion of students currently using tobacco products who used a product ≥20 of the past 30 days ranged from 14.0% of cigar smokers to 38.7% of smokeless tobacco users among high school students and from 13.1% of e-cigarette users to 24.5% of hookah smokers among middle school students.

Influenza activity in the United States was low during October 2018, and, although it increased slowly during November, activity remains low across most of the country.

In 2017, among adults aged ≥18 years, those with a diagnosis of diabetes were more likely to have had an influenza vaccination in the past 12 months than were those with a diagnosis of prediabetes (62.5% versus 56.1%); those with no diagnosed diabetes were the least likely to have had an influenza vaccination (40.1%).

From 2014 to 2017, the annual rate of false positive diagnosis pf human immunodeficiency virus in Chókwè district, Mozambique decreased from 0.66% to 0.00%, and the cumulative false diagnosis rate was 0.56%, compared with the median rate of 3.1% reported in the systematic review.

During 2016, 11 infants were born to women in Los Angeles County who met the Council of State and Territorial Epidemiologists case definition for confirmed (four infants) or probable (seven) Zika virus infection.

Although secondhand smoke exposure among U.S. nonsmokers declined from 87.5% to 25.2% during 1988-2014, one in four nonsmokers, including 14 million children, were exposed to secondhand smoke during 2013-2014.

In June 2017, PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified 17 Salmonella Agbeni clinical isolates with indistinguishable XbaI enzyme pattern (outbreak strain) by pulsed-field gel electrophoresis.

The percentage of adults aged 20-64 who had a blood cholesterol check by a health professional in the past 12 months increased from 58.0% in 2012 to 65.5% in 2017.

During 1999-2015 and 1999-2016, uterine cancer incidence and mortality rates increased 0.7% and 1.1% per year, respectively, with black women disproportionately affected.

Monitoring procedures for highly pathogenic avian influenza responders were successfully implemented during a 2016 outbreak of highly pathogenic avian influenza A(H7N8) in commercial turkey flocks in Indiana. No human cases of avian influenza were identified.

This report details the first documented outbreak of adenovirus D53 epidemic keratoconjunctivitis in the United States. Seventeen epidemic keratoconjunctivitis cases were identified; after the primary case, all cases occurred in eye care clinic patients or their household contacts. Infection prevention lapses were associated with the outbreak, specifically improper ocular equipment disinfection.

Since September 2015, the World Health Organization has recommended antiretroviral therapy (ART) for all persons with human immunodeficiency virus (HIV) infection, regardless of clinical stage or CD4 count (1).

Compared with other racial/ethnic groups, American Indians/Alaska Natives (AI/AN) have a lower life expectancy, lower quality of life, and are disproportionately affected by many chronic conditions (1,2).

In 2010, the World Health Assembly set three milestones for measles prevention to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district; 2) reduce global annual measles incidence to less than five cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (1).*

Haemaphysalis longicornis is a tick indigenous to eastern Asia and an important vector of human and animal disease agents, resulting in such outcomes as human hemorrhagic fever and reduction of production in dairy cattle by 25%. H. longicornis was discovered on a sheep in New Jersey in August 2017 (1).

The U.S. territory of American Samoa has experienced recent outbreaks of illnesses caused by viruses transmitted by Aedes species mosquitoes, including dengue, chikungunya, and Zika virus.

World AIDS Day, observed each year on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic worldwide.

Overall, 46.7% of women and 39.9% of men aged ≥18 years have had a flu vaccination in the past 12 months. For both sexes, as age increased, a higher percentage of adults had a flu vaccination.

Arthritis occurs in 27% of adults in Montana, among whom 50% have activity limitations, 16% have social participation restrictions, and 23% have severe joint pain attributable to arthritis (1).

On November 24, 2017, MMWR published "Abortion Surveillance - United States, 2014" (1). On August 6, 2018, the authors informed MMWR about inadvertent errors in the data that resulted in publication of some erroneous numbers for gestational ages and abortion ratios throughout the report.

The number of pediatric cases of elevated blood lead levels (BLLs) are decreasing in North Carolina.

On November 28, 2017, the manager of restaurant A in Tennessee reported receiving 18 complaints from patrons with gastrointestinal illness who had dined there on Thanksgiving Day, November 23, 2017.

During 2016, 10.1% of all ED visits in the United States were made by patients with depression documented in their medical record.

Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig's disease, is a progressive and fatal neuromuscular disease; the majority of ALS patients die within 2-5 years of receiving a diagnosis (1).

The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that provides expert advice to the Director of CDC and the Secretary of the U.S. Department of Health and Human Services in the form of recommendations on the use of vaccines and related agents for control of vaccine-preventable diseases in the U.S. civilian population.

On April 1, 2016, MMWR Surveillance Summaries published "Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years-Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012" (1).

Endorsed by the World Health Assembly in 2012, the Global Vaccine Action Plan 2011-2020 (GVAP) (1) calls on all countries to reach ≥90% national coverage with all vaccines in the country's national immunization schedule by 2020.

During 2000-2016, the suicide rate among the U.S. working age population (persons aged 16-64 years) increased 34%, from 12.9 per 100,000 population to 17.3 (https://www.cdc.gov/injury/wisqars).

Dracunculiasis (Guinea worm disease), caused by the parasite Dracunculus medinensis, is acquired by drinking water containing copepods (water fleas) infected with its larvae.

Electronic cigarettes (e-cigarettes) are battery-powered devices that provide nicotine and other additives to the user in the form of an aerosol (1). E-cigarettes entered the U.S. marketplace in 2007 (1), and by 2014, e-cigarettes were the most commonly used tobacco product among U.S. youths (2).

In August 2018, CDC noted an increased number of reports of patients having symptoms clinically compatible with acute flaccid myelitis (AFM), a rare condition characterized by rapid onset of flaccid weakness in one or more limbs and spinal cord gray matter lesions, compared with August 2017.

On July 1, 2016, MMWR published "Suicide Rates by Occupational Group - 17 States, 2012" (1). On June 14, 2018, the authors informed MMWR about their concerns regarding the validity of some of the findings in the report, and on June 29, 2018, MMWR published "Notice to Readers: Ongoing Analysis of Suicide Rates Data by Occupational Group from Results Reported in MMWR" (2). The analysis is complete, and because the corrections change the conclusions, the original report is retracted.

The American Cancer Society's 43rd annual Great American Smokeout will be held on November 15, 2018. The Great American Smokeout is an annual event that encourages smokers to make a plan to quit smoking.

In the report "Translocation of a Stray Cat Infected withRabies from North Carolina to a Terrestrial Rabies-Free Countyin Ohio, 2017,"

Pakistan remains one of only three countries worldwide that has never had interrupted wild poliovirus serotype 1 transmission.

Firearm homicide rates in large metro areas and the nation have risen back to rates similar to those seen during 2006-2007. Firearm suicide rates continued to increase, both nationally and in large metro areas overall. Firearm homicides and suicides pose a continuing public health concern in the United States.

In January 2018, the Indiana State Department of Health was notified of a case of Cronobacter sakazakii meningitis in an infant who had been fed exclusively maternal milk.