Pickens CM, Park J, Casillas SM
… +5 more, Liu S, Sheppard M, Stokes EK, Ko JY, Lee SH
MMWR Morb Mortal Wkly Rep
· 2025 May · PMID 40338824
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Fatal overdoses involving synthetic opioids such as fentanyl increased sharply during the past decade. Recent data indicate declines in deaths with illegally manufactured fentanyls detected beginning in mid-2023. However...Fatal overdoses involving synthetic opioids such as fentanyl increased sharply during the past decade. Recent data indicate declines in deaths with illegally manufactured fentanyls detected beginning in mid-2023. However, timely data on nonfatal overdoses involving fentanyl are limited. Emergency department (ED) data from CDC's National Syndromic Surveillance Program during October 2020-March 2024 were analyzed. Quarterly trends in rates of suspected nonfatal overdose of unintentional or undetermined intent involving fentanyl or fentanyl analogs (fentanyl-involved nonfatal overdoses) (i.e., the number of ED visits for fentanyl-involved nonfatal overdose per 10,000 total ED visits) were analyzed overall and by age group, sex, and race and ethnicity. During quarter (Q) 4 (October-December) 2020 to Q3 (July-September) 2023, rates of fentanyl-involved nonfatal overdose ED visits increased 8.7% per quarter, from 1.4 to 3.5 per 10,000 ED visits, then declined 11.0% per quarter, to 2.9 per 10,000 ED visits, from Q3 2023 to Q1 (January-March) 2024. Trends increased among a majority of demographic groups through mid-2023, with the highest rates and the largest increases among non-Hispanic American Indian or Alaska Native persons (e.g., 11.9 per 10,000 ED visits in Q3 2023, and an average quarterly increase of 9.0%, respectively). Providers in EDs have an important role in preventing fentanyl-involved nonfatal overdoses. Buprenorphine, a medication used to treat opioid use disorder that can be initiated in an ED, might benefit persons who use EDs as a main source of medical care. In addition, comprehensive services, including screening and treatment of co-occurring mental health conditions, as well as evidence-based prevention, treatment, and recovery support services, might be initiated in EDs because these might be particularly important in communities at high risk for fentanyl overdoses.
Patton ME, Moline HL, Whitaker M
… +44 more, Tannis A, Pham H, Toepfer AP, Taylor CA, Goldstein L, Reingold A, Kirley PD, Alden NB, Kawasaki B, Meek J, Kim D, Witt LS, Openo KP, Ryan PA, Mumm E, Lynfield R, Salazar-Sanchez Y, Pacheco F, Keating F, Anderson BJ, Tesini BL, Felsen CB, Sutton M, Thomas A, Schaffner W, Talbot HK, Harbi K, Doran E, Weinberg GA, Staat MA, Payne DC, Halasa NB, Stewart L, Boom JA, Sahni LC, Klein EJ, Englund JA, Williams JV, Michaels MG, Schuster JE, Selvarangan R, Szilagyi PG, Havers FP, Dawood FS
MMWR Morb Mortal Wkly Rep
· 2025 May · PMID 40338822
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Maternal respiratory syncytial virus (RSV) vaccine and nirsevimab, a long-acting monoclonal antibody for infants aged 0-7 months and children aged 8-19 months who are at increased risk for severe RSV disease, became wide...Maternal respiratory syncytial virus (RSV) vaccine and nirsevimab, a long-acting monoclonal antibody for infants aged 0-7 months and children aged 8-19 months who are at increased risk for severe RSV disease, became widely available for prevention of severe RSV disease among infants and young children during the 2024-25 RSV season. To evaluate the association between availability of these products and infant and child RSV-associated hospitalization rates, the rates among children aged <5 years were compared for the 2024-25 and 2018-20 RSV seasons using data from the RSV-Associated Hospitalization Surveillance Network (RSV-NET) and New Vaccine Surveillance Network (NVSN). Among infants aged 0-7 months (eligible for protection with maternal vaccination or nirsevimab), 2024-25 RSV-associated hospitalization rates were lower compared with 2018-20 pooled rates (estimated relative rate reductions of 43% [RSV-NET: 95% CI = 40%-46%] and 28% [NVSN: 95% CI = 18%-36%]). The largest estimated rate reduction was observed among infants aged 0-2 months (RSV-NET: 52%, 95% CI = 49%-56%; NVSN: 45%, 95% CI = 32%-57%) and during peak hospitalization periods (December-February). These findings support Advisory Committee on Immunization Practices' recommendations for maternal vaccination or nirsevimab to protect against severe RSV disease in infants and highlight the importance of implementing the recommendations to protect infants as early in the RSV season as possible, before peak transmission, and for infants born during the RSV season, within the first week of life, ideally during the birth hospitalization.
Nham A, Le JN, Thomas SA
… +27 more, Gressick K, Ussery EN, Ko JY, Gladden RM, Mikosz CA, Schier JG, Vivolo-Kantor A, Fiorillo M, McMaster M, Magana DN, Verklan-McInnes L, Wahl M, Wood T, Adams A, Krotulski A, Trecki J, Ellison R, Gerona R, Arunkumar P, Mir M, Wise LM, Betancourt E, Monty K, Gulmatico J, Pojas A, Fitzgerald R, Hua M
MMWR Morb Mortal Wkly Rep
· 2025 May · PMID 40310760
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Medetomidine, a nonopioid sedative not approved for use in humans, has periodically been detected in illegally manufactured opioids across North America since 2022. On May 11, 2024, the Chicago Department of Public Healt...Medetomidine, a nonopioid sedative not approved for use in humans, has periodically been detected in illegally manufactured opioids across North America since 2022. On May 11, 2024, the Chicago Department of Public Health (CDPH) and the Illinois Department of Public Health were alerted by hospitals and the Illinois Poison Center to an increase in emergency medical services responses for suspected opioid-involved overdoses with atypical symptoms, mostly clustered on Chicago's West Side. CDPH and CDC investigated and identified 12 confirmed, 26 probable, and 140 suspected overdoses involving medetomidine mixed with opioids among patients treated at three hospitals in Chicago's West Side during May 11-17, 2024. Medetomidine had not been previously identified in Chicago's illegal drug supply. Fentanyl was identified in all drug samples and blood specimens containing medetomidine. Most patients were male, non-Hispanic Black or African American, and aged 45-64 years; most patients with confirmed cases experienced bradycardia and had no or only a partial response to naloxone. This cluster is the largest reported for confirmed medetomidine-involved overdoses. Multisector surveillance, including by health care providers, toxicology laboratories, and public health personnel, was essential for quickly identifying and responding to new adulterants in the illegal drug supply. Because all specimens and samples in this investigation that contained medetomidine also contained natural or synthetic opioids, administering naloxone for all suspected opioid-involved overdoses remains crucial.
VanFrank B, Pasalic E, Oliver B
… +10 more, Caron K, Nerurkar K, Marynak K, Jamal A, Palipudi K, Mahoney M, Schecter A, Recasner C, Hazelwood E, Tomoyasu N
MMWR Morb Mortal Wkly Rep
· 2025 Apr · PMID 40273088
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Evidence-based cessation treatments and tobacco-free policies support and increase smoking cessation, which has positive physical health impacts and is associated with positive behavioral health outcomes. Implementation...Evidence-based cessation treatments and tobacco-free policies support and increase smoking cessation, which has positive physical health impacts and is associated with positive behavioral health outcomes. Implementation of these strategies in substance use and mental health treatment facilities (behavioral health treatment facilities) could help decrease tobacco use among persons with behavioral health conditions. Data from the 2023 National Substance Use and Mental Health Services Survey were analyzed to ascertain the number and percentage of behavioral health treatment facilities that offered tobacco-related clinical services and had tobacco-free policies. In 2023, tobacco cessation counseling was the most commonly offered cessation service in facilities treating mental health conditions (53.1%) and substance use disorders (69.9%). Fewer than one half of facilities offered nicotine replacement therapy (35.0% of mental health and 40.2% of substance use facilities) or non-nicotine cessation medication (33.6% of mental health and 35.3% of substance use facilities). Policies prohibiting both smoking and vaping were reported by 53.9% of mental health and 33.9% of substance use facilities. Among facilities with a tobacco-free policy, 64.4% of mental health and 81.8% of substance use facilities offered at least one cessation service. Opportunities remain to improve cessation supports in behavioral health treatment facilities, including tobacco-free policies and integrated tobacco cessation treatment services. These strategies could help decrease tobacco-related disease and improve behavioral health outcomes.
Troeschel AN, Buser MC, Winquist A
… +19 more, Ruckart P, Yeh M, Kuai D, Chang A, Pennington AF, Rumph JT, Smith MR, Lara MV, Cataldo N, Lewis K, Arnold K, Harris S, Nicholas DC, Hughes M, Wortmann T, Norman E, Napier MD, Dillard J, Daniel J
MMWR Morb Mortal Wkly Rep
· 2025 Apr · PMID 40273027
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Although lead poisoning can cause detrimental health effects, it is largely preventable. Common exposure sources include contaminated soil, water, and lead-based paint in homes built before the 1978 ban on residential le...Although lead poisoning can cause detrimental health effects, it is largely preventable. Common exposure sources include contaminated soil, water, and lead-based paint in homes built before the 1978 ban on residential lead-containing paint. In North Carolina, testing for lead is encouraged for all children at ages 1 and 2 years, and is required for children covered by Medicaid. In October 2023, routine pediatric blood lead testing and follow-up investigations conducted by the North Carolina Department of Health and Human Services identified four asymptomatic cases of lead poisoning associated with consumption of cinnamon-containing applesauce packaged in pouches. The Food and Drug Administration (FDA) identified lead in the cinnamon as the source of contamination; chromium was later also detected in the cinnamon. FDA alerted the public on October 28, and the distributor initiated a voluntary recall the following day. To estimate the impact of the event and characterize reported cases, CDC initiated a national call for cases (defined as a blood lead level [BLL] ≥3.5 μg/dL in a person of any age in ≤3 months after consuming a recalled cinnamon-containing applesauce product). During November 22, 2023-April 12, 2024, a total of 44 U.S. states, the District of Columbia, and Puerto Rico reported 566 cases (55% in children aged <2 years, including 20% that were temporally associated with symptoms). The median maximum venous BLL was 7.2 μg/dL (range = 3.5-39.3 μg/dL). The hundreds of children poisoned by this incident highlight the importance of preventing toxic metal contamination of food and promoting routine childhood blood lead testing and follow-up to identify lead exposure sources. Clinicians and public health practitioners should be aware of the potential for exposure to toxic metals from less common sources, including food.
Mathis AD, Raines K, Filardo TD
… +12 more, Wiley N, Leung J, Rota PA, Martinez D, Rai S, Shetty V, Holzinger N, Stanislawski E, Daskalakis DC, Chatham-Stephens K, Patel M, Sugerman D
MMWR Morb Mortal Wkly Rep
· 2025 Apr · PMID 40273019
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A multistate measles outbreak, predominantly affecting members of close-knit communities with low measles vaccination coverage in New Mexico, Oklahoma, and Texas began in January 2025. As of April 17, a total of 800 case...A multistate measles outbreak, predominantly affecting members of close-knit communities with low measles vaccination coverage in New Mexico, Oklahoma, and Texas began in January 2025. As of April 17, a total of 800 cases have been reported in the United States in 2025; 654 (82%) cases in New Mexico, Oklahoma, and Texas have been associated with the ongoing outbreak. These cases represent an approximately 180% increase over the 285 measles cases reported in the United States during all of 2024, and the second highest annual case count in the United States in 25 years. Overall, 771 (96%) patients have been unvaccinated or had unknown vaccination status (77% were unvaccinated, and 14% had unknown vaccination status when excluding 590 cases reported by Texas, which requires explicit consent by law [i.e., opt-in] to enroll in the Texas Immunization Registry), 85 (11%) patients have been hospitalized, and three patients have died. Among 48 (6%) internationally imported cases, 44 (92%) occurred among U.S. residents. Endemic measles was declared eliminated in the United States in 2000 as a direct result of high 2-dose childhood coverage with the measles, mumps, and rubella (MMR) vaccine. However, measles cases and outbreaks continue to occur when travelers with measles return to the United States while they are infectious; larger U.S. outbreaks typically follow importation into close-knit communities with low vaccination coverage. Nationally, risk for widespread measles transmission remains low because of high population-level immunity. To prepare for and prevent measles cases and outbreaks, public health departments should continue working with trusted community messengers on culturally competent community engagement, education, vaccination efforts, and other community infection prevention approaches (e.g., case isolation, contact monitoring, and post-exposure prophylaxis) and coordinating with health care facilities and schools. Increasing national and local MMR vaccination coverage is essential to preventing measles cases and outbreaks.
Zhu S, Grant C, Pan CY
… +39 more, Adcock B, Kao A, Stous S, Yee L, Springfield O, Poranski M, Kennar A, Beatty M, Shah S, Watson H, Buonomo H, Manlutac ALM, Lima H, Mendez D, Clark B, Pulido M, Bakshi M, Contreras C, Green N, Burleson T, Forester J, Klish SW, Feaster M, Taylor EV, Balanji N, Kho V, Hatada A, Wright C, Morales C, Abbott M, Burditt FR, Elliot E, Jones JL, Kinsey M, Lombardi M, Phelps K, Woods JW, Kimura A, Lamba K
MMWR Morb Mortal Wkly Rep
· 2025 Apr · PMID 40244935
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Norovirus is the most common cause of foodborne illness outbreaks in the United States. In January 2024, local health jurisdictions and the California Department of Public Health (CDPH) identified two concurrent noroviru...Norovirus is the most common cause of foodborne illness outbreaks in the United States. In January 2024, local health jurisdictions and the California Department of Public Health (CDPH) identified two concurrent norovirus outbreaks across eight Southern California local health jurisdictions. CDPH was notified in late December 2023 and early January 2024 of gastrointestinal illnesses in persons who consumed raw oysters from food service facilities in San Diego County (outbreak 1). Additional illness reports came from multiple jurisdictions that included Los Angeles County and other areas in Southern California (outbreak 2). In total, approximately 400 persons across eight local health jurisdictions reported gastrointestinal illness after raw oyster consumption. A multiagency investigation confirmed that outbreaks 1 and 2 were unrelated, and implicated oysters were traced to two separate, nonoverlapping harvest regions in Mexico. A total of 179 outbreak-associated cases, including 24 laboratory-confirmed norovirus cases, were identified. Patient samples from both outbreaks identified norovirus genogroups I and II; other enteric viruses (sapovirus, astrovirus, rotavirus, and adenovirus) were also identified from one or both outbreaks. Noroviruses were genetically related by genotype within each outbreak but dissimilar between outbreaks. In outbreak 2, oysters might have been contaminated at a location separate from the original growing area, also known as wet storage. Concurrent outbreaks with similar modes of transmission can be unrelated, and the source for each should be confirmed through traceback. Proper storage and handling of shellfish is essential to maintaining safety of food products to consumers. Cooking oysters to 145°F (62.8°C) is recommended before consumption.
Goetzman J, Carter A, Oliveira A
… +1 more, Ingram LA
MMWR Morb Mortal Wkly Rep
· 2025 Apr · PMID 40244909
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In early June 2023, the Alabama Department of Public Health identified five laboratory-confirmed cyclosporiasis case reports with a common patient exposure of eating at one Mexican-style restaurant. Common signs of cyclo...In early June 2023, the Alabama Department of Public Health identified five laboratory-confirmed cyclosporiasis case reports with a common patient exposure of eating at one Mexican-style restaurant. Common signs of cyclosporiasis include diarrhea, abdominal cramps, nausea, and loss of appetite. Although most illnesses are self-limited, antibiotic treatment can prevent relapsing illness. Onset of illness for the initial five patients occurred during May 26-30. An outbreak investigation was initiated on June 7. Routine case investigations and case finding through the restaurant's food delivery service contact list identified 42 additional cases. Multivariable analysis of case-control study data revealed that illness was associated with consumption of cilantro (odds ratio = 40.9; 95% CI = 6.4-808.6). The cilantro was traced back to a Texas firm with no identified food manufacturing license that sourced the product from Mexico. The outbreak and its investigation demonstrate the ongoing need for regulatory controls of produce suppliers, documentation and review of business licenses, and increasing public awareness of food safety and outbreaks. Distribution of potentially contaminated products via improper supply chain channels remains a public health challenge. Avoiding infection in the United States involves preventing contaminated produce from reaching local retailers and consumers.
Quader ZS, Roehler DR, Vivolo-Kantor AM
… +1 more, Ko JY
MMWR Morb Mortal Wkly Rep
· 2025 Apr · PMID 40208833
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Access to and use of cannabis in the United States has increased as new product types emerge in the marketplace, and as additional states legalize its use for medical and nonmedical purposes. To tailor education messages...Access to and use of cannabis in the United States has increased as new product types emerge in the marketplace, and as additional states legalize its use for medical and nonmedical purposes. To tailor education messages for preventing adverse health effects of cannabis use, understanding the routes of use of these products in the general population is important. The 2022 Behavioral Risk Factor Surveillance System included a newly revised optional marijuana module comprising questions on marijuana routes of use among adults aged ≥18 years who used marijuana during the past 30 days (current use). Twenty-two states and two territories administered the optional marijuana module in 2022. Weighted prevalences (with 95% CIs) of current and daily or near-daily marijuana use, as well as prevalence of each route of use, were reported overall and by demographic characteristics and, among women aged ≤49 years, by pregnancy status. Among the 15.3% of respondents who reported current marijuana use, smoking was the most frequent route (79.4%), followed by eating (41.6%), vaping (30.3%), and dabbing (inhaling heated concentrated cannabis) (14.6%). Vaping and dabbing were most prevalent among persons aged 18-24 years. Intervention measures intended for persons who smoke cannabis are important; however, understanding health outcomes associated with other routes of use might have substantial public benefit.
MMWR Morb Mortal Wkly Rep
· 2025 Apr · PMID 40208829
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Psychostimulant (stimulant)-related overdose death rates have increased sharply in the United States since 2010, and in 2022, 32% of all U.S. overdose deaths involved stimulants. Data on deaths during 2017-2022 from CDC'...Psychostimulant (stimulant)-related overdose death rates have increased sharply in the United States since 2010, and in 2022, 32% of all U.S. overdose deaths involved stimulants. Data on deaths during 2017-2022 from CDC's State Unintentional Drug Overdose Reporting System were linked to 2014-2022 Pennsylvania Prescription Drug Monitoring Program data; the Pennsylvania Department of Health's Office of Drug Surveillance and Misuse Prevention analyzed controlled substance dispensation patterns during the 3 years preceding death among overdose decedents for whom opioids, stimulants, or both contributed to death; statistical analyses were performed on prescription drug dispensation patterns. Comparing overdose deaths in 2022 with those in 2017, deaths involving opioids without stimulants decreased from 2,974 to 1,995, deaths involving stimulants without opioids increased from 300 to 549, and deaths involving both opioids and stimulants increased from 1,703 to 2,346. Irrespective of whether an opioid, stimulant, or both contributed to death, decedents filled more opioid (67.7%, 74.1%, and 63.9%, respectively) than stimulant (10.6%, 11.6%, and 13.4%, respectively) prescriptions preceding death. A higher proportion of stimulant overdose decedents without an opioid contributing to death (74.1%) filled opioid prescriptions compared with decedents whose deaths involved opioids without stimulants or both opioids and stimulants (67.7% and 63.9%, respectively). Opioid prescribing, rather than stimulant prescribing, might be an important potential risk factor for stimulant-related overdose death.