High prevalence of ceftriaxone-resistant and XDR Neisseria gonorrhoeae in several cities of Cambodia, 2022-23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP)

Objectives

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022-June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated N. gonorrhoeae AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia.

Methods

Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire.

Results

From 437 male patients, 306 had positive N. gonorrhoeae cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR N. gonorrhoeae. These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400 mg plus azithromycin 1 g (65.4%) or ceftriaxone 1 g plus azithromycin 1 g (34.6%) was used for treatment.

Conclusions

A high prevalence of ceftriaxone-resistant, MDR and XDR N. gonorrhoeae in several cities of Cambodia were found during 2022-23 in WHO EGASP. This necessitates expanded N. gonorrhoeae AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.

Were Needles Everywhere?: Differing Views on Syringe Waste and Disposal Associated With Needs-Based Syringe Services Programs Among Community Partners and Persons Who Inject Drugs

BACKGROUND

Community concerns surrounding syringe waste are a common barrier to syringe services program (SSP) implementation. In Kanawha County, West Virginia, community opposition to SSPs resulted in the closure of needs-based SSPs prior to and during an HIV outbreak among persons who inject drugs (PWID). This qualitative analysis examines views of PWID and community partners on syringe waste and disposal associated with needs-based SSPs.

METHODS

Qualitative interviews with 26 PWID and 45 community partners (medical and social service providers, law enforcement personnel, policymakers, and religious leaders) were conducted. Interviews were recorded, transcribed, and coded. Code summaries described participants' views on syringe waste and disposal and needs-based SSPs.

RESULTS

Community partners and PWID who favored needs-based SSPs reported that needs-based SSPs had not affected or reduced syringe waste. Conversely, community partners who favored one-to-one exchange models and/or barcoded syringes described needs-based SSPs increasing syringe waste. Community partners often cited pervasive community beliefs that SSPs increased syringe waste, risk of needlesticks, drug use, and crime. Community partners were unsure how to address syringe waste concerns and emphasized that contradictory views on syringe waste posed barriers to discussing and implementing SSPs.

CONCLUSIONS

Participants' views on whether syringe waste was associated with needs-based SSPs often aligned with their support or opposition for needs-based SSPs. These differing views resulted in challenges finding common ground to discuss SSP operations amid an HIV outbreak among PWID. SSPs might consider addressing syringe waste concerns by expanding syringe disposal efforts and implementing community engagement and stigma reduction activities.

A Qualitative Analysis of Barriers to Accessing HIV Prevention Services During an HIV Outbreak among Persons who Inject Drugs in West Virginia

In response to an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County, West Virginia, West Virginia Bureau for Public Health and CDC conducted a qualitative assessment in Kanawha County to inform HIV outbreak response activities. Interviews with 26 PWID and 45 community partners were completed. Transcribed interviews were analyzed to identify barriers to accessing HIV prevention services among PWID using the risk environment framework. Participants identified numerous political, physical, social, and economic community-level barriers that influenced access to HIV prevention services among PWID. Political factors included low community support for syringe services programs (SSPs); physical factors included low SSP coverage, low coverage of HIV testing outreach events, low HIV preexposure prophylaxis availability, and homelessness; social factors included stigma and discrimination; economic factors included community beliefs that SSPs negatively affect economic investments and limited resources for HIV screening in clinical settings. Individual-level barriers included co-occurring acute medical conditions and mental illness. Community-level interventions, such as low-barrier one-stop shop models, are needed to increase access to sterile syringes through comprehensive harm reduction services.

The Congenital Syphilis Prevention Cascade: Reimagining a Missed Prevention Opportunities Framework for Effective Intervention

ABSTRACT

Congenital syphilis (CS) rates have risen in the United States since 2013. Prevention of CS requires testing and treatment of pregnant and pregnancy-capable persons at high risk for syphilis. We developed a CS Prevention Cascade to assess how effectively testing and treatment interventions reached pregnant persons with a CS outcome.

Vital Signs: Missed Opportunities for Preventing Congenital Syphilis - United States, 2022

Introduction

Congenital syphilis cases in the United States increased 755% during 2012-2021. Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death, and maternal and infant morbidity; these outcomes can be prevented through appropriate screening and treatment.

Methods

A cascading framework was used to identify and classify missed opportunities to prevent congenital syphilis among cases reported to CDC in 2022 through the National Notifiable Diseases Surveillance System. Data on testing and treatment during pregnancy and clinical manifestations present in the newborn were used to identify missed opportunities to prevent congenital syphilis.

Results

In 2022, a total of 3,761 cases of congenital syphilis in the United States were reported to CDC, including 231 (6%) stillbirths and 51 (1%) infant deaths. Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis. Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions.

Conclusions and implications for public health practice

Addressing missed opportunities for prevention, primarily timely testing and appropriate treatment of syphilis during pregnancy, is important for reversing congenital syphilis trends in the United States. Implementing tailored strategies addressing missed opportunities at the local and national levels could substantially reduce congenital syphilis.

Monodentate Alkoxy/Aryloxy Anchored Yttrium Dihydrides; Anticipated Outcomes and Surprises

The synthesis, characterization, and solid-state structure of bulky alkoxy- and aryloxy-supported yttrium polynuclear hydrides are reported. Hydrogenolysis of the supertrityl alkoxy anchored yttrium dialkyl, Y(OTr*)(CH₂SiMe₃)₂(THF)₂ (1) (Tr* = tris(3,5-di-tert-butylphenyl)methyl), resulted in the clean conversion to the tetranuclear dihydride, [Y(OTr*)H₂(THF)]₄ (1a). X-ray analysis revealed a highly symmetrical structure (4̅ site symmetry) with the four Y atoms located on the corners of a compressed tetrahedron, each bonded to an OTr* and tetrahydrofuran (THF) ligand and the cluster held together by four face-capping, μ₃-H, and four edge-bridging, μ₂-H, hydrides. DFT calculations on the full system with and without THF, but also on model systems, clearly show that the structural preference for complex 1a is controlled by the presence and coordination of THF molecules. Contrary to the exclusive formation of the tetranuclear dihydride, hydrogenolysis of the bulky aryloxy yttrium dialkyl, Y(OAr*)(CH₂SiMe₃)₂(THF)₂ (2) (Ar* = 3,5-di-tert-butylphenyl) gave a mixture of the analogous tetranuclear 2a and trinuclear, [Y₃(OAr*)₄H₅(THF)₄], polyhydride, 2b. Similar results, i.e., a mixture of tetra-/tri-nuclear products, were obtained from hydrogenolysis of the even bulkier Y(OAr^Ad2,Me)(CH₂SiMe₃)₂(THF)₂ compound. Experimental conditions were established to optimize the production of either the tetra- or trinuclear products. X-ray structure of 2b revealed a triangular array of three yttrium atoms with two face-capping μ₃-H and three edge-bridging μ₂-H hydrides, with one yttrium bonded to two aryloxy ligands while the other two have a complement of one aryloxy and two THF ligands; the solid-state structure is close to being C₂ symmetric, with the C₂ axis running through the unique Y and unique μ₂-H hydride. As opposed to 2a, which shows distinct ¹H NMR resonances for μ₃/ μ₂-H (δ = 5.83/6.35 ppm, respectively), no hydride signals for 2b were observed at room temperature, indicating hydride exchange on the NMR time scale. Their presence and assignment were secured at -40 °C from ¹H SST (spin saturation) experiment.

The CDC Domestic Mpox Response - United States, 2022-2023

Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.S. Public Health Emergency on August 4, 2022, by the U.S. Department of Health and Human Services.^† A U.S. government response was initiated, and CDC coordinated activities with the White House, the U.S. Department of Health and Human Services, and many other federal, state, and local partners. CDC quickly adapted surveillance systems, diagnostic tests, vaccines, therapeutics, grants, and communication systems originally developed for U.S. smallpox preparedness and other infectious diseases to fit the unique needs of the outbreak. In 1 year, more than 30,000 U.S. mpox cases were reported, more than 140,000 specimens were tested, >1.2 million doses of vaccine were administered, and more than 6,900 patients were treated with tecovirimat, an antiviral medication with activity against orthopoxviruses such as Variola virus and Monkeypox virus. Non-Hispanic Black (Black) and Hispanic or Latino (Hispanic) persons represented 33% and 31% of mpox cases, respectively; 87% of 42 fatal cases occurred in Black persons. Sexual contact among gay, bisexual, and other men who have sex with men (MSM) was rapidly identified as the primary risk for infection, resulting in profound changes in our scientific understanding of mpox clinical presentation, pathogenesis, and transmission dynamics. This report provides an overview of the first year of the response to the U.S. mpox outbreak by CDC, reviews lessons learned to improve response and future readiness, and previews continued mpox response and prevention activities as local viral transmission continues in multiple U.S. jurisdictions (Figure).

Mpox virus and transmission through sexual contact: Defining the research agenda

In a Policy Forum piece, Dr. Nicola Low and colleagues define the research agenda for Mpox virus and transmission through sexual contact.

Characteristics of JYNNEOS Vaccine Recipients Before and During a Large Multiday LGBTQIA+ Festival - Louisiana, August 9-September 5, 2022

Since May 2022, 27,558 monkeypox cases have been identified in the United States (1). Gay, bisexual, and other men who have sex with men (MSM) represent the most affected demographic group in the current multinational outbreak (2). As of October 18, 2022, Louisiana had reported 273 monkeypox cases with 187 (68.5%) among residents of the Louisiana Department of Health (LDH) Southeast Region, which includes the city of New Orleans (3).

Reported Neurologic, Ocular, and Otic Manifestations Among Syphilis Cases-16 States, 2019

BACKGROUND

Syphilis can cause neurologic, ocular, or otic manifestations, possibly resulting in permanent disability or death. In 2018, the Centers for Disease Control and Prevention began collecting syphilis clinical manifestation data via the National Notifiable Diseases Surveillance System. We present the first reported US syphilis neurologic, ocular, and otic manifestation prevalence estimates.

METHODS

We reviewed 2019 National Notifiable Diseases Surveillance System data to identify jurisdictions reporting 70% or greater of syphilis cases 15 years or older with clinical manifestation data (considered "complete reporting"). Among these jurisdictions, we determined reported neurologic, ocular, and otic manifestation prevalence, stratified by demographic, behavioral, and clinical characteristics.

RESULTS

Among 41,187 syphilis cases in 16 jurisdictions with complete reporting, clinical manifestations were infrequently reported overall: neurologic (n = 445, 1.1%), ocular (n = 461, 1.1%), otic (n = 166, 0.4%), any (n = 807, 2.0%). Reported clinical manifestation prevalence was highest among cases 65 years or older (neurologic, 5.1%; ocular, 3.5%; otic, 1.2%) and those reporting injection drug use (neurologic: 2.8%; ocular: 3.4%; otic: 1.6%). Although reported neurologic and ocular manifestation prevalence was slightly higher among human immunodeficiency virus (HIV)-infected versus HIV-negative persons, approximately 40% of cases with manifestations were HIV-negative. Reported otic manifestation prevalence was similar regardless of HIV status. When stratifying by HIV status and syphilis stage, reported prevalence was highest among HIV-infected persons with unknown duration/late syphilis (neurologic, 3.0%; ocular, 2.3%; otic, 0.7%).

CONCLUSIONS

Reported neurologic, ocular, and otic manifestation prevalence was low among syphilis cases, but these data are likely an underestimate given potential underreporting. Reported clinical manifestation frequency, including among HIV-negative persons, emphasizes the importance of evaluating all syphilis cases for signs/symptoms of neurosyphilis, ocular syphilis, and otosyphilis.

The first week following insemination is the period of major pregnancy failure in pasture-grazed dairy cows

A 60% pregnancy success for inseminations is targeted to optimize production efficiency for dairy cows within a seasonal, pasture-grazed system. Routine measures of pregnancy success are widely available but are limited, in practice, to a gestation stage beyond the first 28 d. Although some historical data exist on embryonic mortality before this stage, productivity of dairy systems and genetics of the cows have advanced significantly in recent decades. Accordingly, the aim was to construct an updated estimate of pregnancy success at key developmental stages during the first 70 d after insemination. Blood samples were collected for progesterone concentrations on d 0 and 7. A temporal series of 4 groups spanning fertilization through d 70 were conducted on 4 seasonal, pasture-grazed dairy farms (n = 1,467 cows) during the first 21 d of the seasonal breeding period. Morphological examination was undertaken on embryos collected on d 7 (group E7) and 15 (group E15), and pregnancy was diagnosed via ultrasonography on approximately d 28 and 35 (group E35) as well as d 70 (group E70). Fertilization, embryo, and fetal evaluation for viability established a pregnancy success pattern. Additionally, cow and on-farm risk factor variables associated with pregnancy success were evaluated. We estimated pregnancy success rates of 70.9%, 59.1%, 63.8%, 62.3%, and 56.7% at d 7, 15, 28, 35, and 70, respectively. Fertilization failure (15.8%) and embryonic arrest before the morula stage (10.3%) were the major developmental events contributing to first-week pregnancy failures. Embryo elongation failure of 7% contributed to pregnancy failure during the second week. The risk factors for pregnancy success that were related to the cows included interval between calving and insemination, and d-7 plasma progesterone concentrations, whereas insemination sire was associated with pregnancy outcome. Most pregnancy failure occurs during the first week among seasonal-calving pasture-grazed dairy cows.

Acid form of Trofimenko&#x2019;s scorpionates, H(Tp^R,R&#x2032;); comments on synthesis and solid-state structure of H(Tp^{<italic>t</italic>Bu,Me})

We report a re-examination of Trofimenko&#x2019;s original protocol for the preparation of the acid form of his hydrotris(pyrazolyl)borates, H(Tp^R,R&#x2032;), by the treatment of M(Tp^R,R&#x2032;)with glacial acetic acid. It is concluded that the protocol is effective as long as the 3-substituent of the pyrazolyl moiety is sufficiently bulky to provide steric protection to the acidic N&#x2013;H proton. The solid-state structure of H(Tp^{<italic>t</italic>Bu,Me}), the acid form of the popular Tp^{<italic>t</italic>Bu,Me} ligand is also presented.

Exploration of diet, physical activity, health knowledge and the cardiometabolic profile of young adults with intellectual disability

BACKGROUND

Young adults with intellectual disability (ID) are experiencing early mortality, and it is suggested that they are living with undiagnosed cardiovascular and metabolic risk factors (hereafter referred to as cardiometabolic).

METHODS

We investigated the association between modifiable risk factors and cardiometabolic health profile in adults with ID aged 18-45 years through clinical evaluation of traditional cardiometabolic parameters, and assessment of physical activity levels, diet and associated health knowledge.

RESULTS

We found that young adults with ID have an increased obesity (mean body mass index; ID group: 32.9 ± 8.6 vs. control group: 26.2 ± 5.5, P = 0.001), are engaging in less physical activity than the age-matched general population (total activity minutes per week; ID group: 172.2 ± 148.9 vs. control group: 416.4 ± 277.1, P < 0.001), and overall have unhealthier diets. Additionally, knowledge about nutrition and physical activity appears to be an important predictor of cardiometabolic risk in this population. If young people with ID are to improve their cardiometabolic health to reduce morbidity and early mortality, we need to further explore how to consistently apply health messaging to get lasting behavioural change in this population.

Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021

On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2).

1359. Reported Neurologic, Ocular, and Otic Manifestations among Syphilis Cases — 16 States, 2019

Background

Syphilis can cause neurologic, ocular, or otic manifestations at any stage, possibly resulting in permanent disability or even death. In 2018, CDC began collecting clinical manifestation data for syphilis cases reported through the National Notifiable Diseases Surveillance System (NNDSS). We present the first estimates of the prevalence of neurologic, ocular, and otic manifestations among syphilis cases in the United States.

Methods

We reviewed NNDSS data to identify jurisdictions (states + DC) who reported ≥ 70% of their syphilis cases with clinical manifestation data (considered to have “complete reporting”) in 2019. Among these jurisdictions, we determined the prevalence of neurologic, ocular, and otic manifestations (combining verified, likely, and possible clinical manifestations together), stratified by HIV status and by syphilis stage (Unknown/late syphilis vs. Early syphilis [Primary, Secondary, and Early non primary non secondary syphilis]).

Results

In 2019, 16 states had complete reporting for neurologic, otic, and ocular manifestations. Of the 41,216 syphilis cases reported in these jurisdictions, clinical manifestations were infrequently reported: neurologic (n=445, 1.1%), ocular (n=461, 1.1%), and otic (n=166, 0.4%). Prevalence was higher among HIV-infected persons compared to HIV-negative persons for neurologic (1.4% vs. 0.9%) and ocular manifestations (1.3% vs 1.0%) but was similar for otic manifestations (0.4% vs 0.4%). Prevalence was higher among persons diagnosed with Unknown/late syphilis compared to Early syphilis for neurologic (1.6% vs 0.8%) and ocular manifestations (1.6% vs 0.9%) but similar for otic manifestations (0.5% vs 0.4%); however, 49.4% of cases reported with ≥ 1 of these clinical manifestations were diagnosed with Early syphilis.

Conclusion

The prevalence of neurologic, ocular, and otic manifestations was low among syphilis cases, but case data likely underestimate the true burden given potential underreporting. The frequency of clinical manifestations, including among HIV-negative persons and persons diagnosed with Early syphilis, emphasizes the importance of evaluating all syphilis cases for clinical signs or symptoms regardless of stage or HIV status.

Disclosures

All Authors: No reported disclosures

Chronic exposure to ∆ 9-tetrahydrocannabinol in adolescence decreases social play behaviours

Background: Cannabis use remains a major public health concern, and its use typically begins in adolescence. Chronic administration of ∆ 9-tetrahydrocannabinol (THC), the main psychoactive compound in cannabis, during adolescence can produce deficits in adult learning and memory, stress reactivity and anxiety. One possible mechanism behind the disruptions in adulthood from adolescent exposure to THC includes changes in social behaviours, such as social play, which has been shown to be critical to socio-cognitive development. Methods: Here, using an established animal model of adolescent THC exposure in male and female Long-Evans rats, we explored the effects of THC on play behaviour during the chronic administration period. Following puberty onset, as indicated by external changes to the genitalia, THC (5mg/kg) was administered for 14 days. Play behaviour was assessed seven days following the onset of the injection period at approximately 1 hour post treatment. The frequency of nape attacks, the likelihood and tactics of defensive behaviour, and pins were scored and analyzed. Results: THC exposure decreased playfulness in adolescent rats including the number of attacks, likelihood of defense and pins compared to control and vehicle treated rats. Conclusion: This suggests that THC suppresses both the attack and defense components of social play. This is an important finding because there is evidence that attack and defense may be mediated by different mechanisms. Furthermore, the effect of THC exposure decreasing playfulness occurred similarly in males and females.

1411 Amoebic Colitis: Inaccurate Diagnosis; Inappropriate Surgery

Global prevalence of symptomatic Amoebiasis (pathogen Entamoeba histolytica) is approximately 50 million cases per year, with an annual mortality of up to 100,000. Despite this, a diagnosis of amoebiasis is rarely considered in the UK. Transmission is via the faeco-oral route, person-to-person contact or oral-anal sexual contact. The majority of cases diagnosed in the UK are in international travellers or immigrants.

Symptoms of amoebiasis can closely mirror those of Inflammatory Bowel Disease (IBD) resulting in diagnostic uncertainty. A misdiagnosis could result in treatment with corticosteroids, immunosuppressant or biological agents when standard treatment for amoebiasis is actually Metronidazole. In exceptional circumstances, a misdiagnosis of IBD may lead to a patient requiring colectomy and formation of end ileostomy due to an apparent failure of medical management. Emergency colonic surgery is associated with a risk of complications such as wound infections and collections, together with the psychological consequences of major illness and surgery.

We report on two patients who have undergone emergency subtotal colectomy and end ileostomy in whom a diagnosis of amoebic colitis was made on histology. Both British Asian patients were under 55 years of age, had a travel history to India and presented with diarrhoea.

The diagnosis of amoebiasis must be considered in the differential diagnosis for all returning travellers and immigrants who present with GI symptoms, consistent with IBD. A correct diagnosis allows appropriate, simple, curative treatment and avoids unnecessary surgery with its attendant morbidity. Polymerase chain reaction is the gold standard diagnostic test and is currently significantly under-utilised.

Congenital Syphilis Diagnosed Beyond the Neonatal Period in the United States: 2014-2018

BACKGROUND AND OBJECTIVES

During 2014-2018, reported congenital syphilis (CS) cases in the United States increased 183%, from 462 to 1306 cases. We reviewed infants diagnosed with CS beyond the neonatal period (>28 days) during this time.

METHODS

We reviewed surveillance case report data for infants with CS delivered during 2014-2018 and identified those diagnosed beyond the neonatal period with reported signs or symptoms. We describe these infants and identify possible missed opportunities for earlier diagnoses.

RESULTS

Of the 3834 reported cases of CS delivered during 2014-2018, we identified 67 symptomatic infants diagnosed beyond the neonatal period. Among those with reported findings, 67% had physical examination findings of CS, 69% had abnormal long-bone radiographs consistent with CS, and 36% had reactive syphilis testing in the cerebrospinal fluid. The median serum nontreponemal titer was 1:256 (range: 1:1-1:2048). The median age at diagnosis was 67 days (range: 29-249 days). Among the 66 mothers included, 83% had prenatal care, 26% had a syphilis diagnosis during pregnancy or at delivery, and 42% were not diagnosed with syphilis until after delivery. Additionally, 24% had an initial negative test result and seroconverted during pregnancy.

CONCLUSIONS

Infants with CS continue to be undiagnosed at birth and present with symptoms after age 1 month. Pediatric providers can diagnose and treat infants with CS early by following guidelines, reviewing maternal records and confirming maternal syphilis status, advocating for maternal testing at delivery, and considering the diagnosis of CS, regardless of maternal history.

Factors Associated With Candida auris Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016-2018

BACKGROUND

Candida auris is an emerging, multidrug-resistant yeast that spreads in healthcare settings. People colonized with C. auris can transmit this pathogen and are at risk for invasive infections. New York State (NYS) has the largest US burden (>500 colonized and infected people); many colonized individuals are mechanically ventilated or have tracheostomy, and are residents of ventilator-capable skilled nursing facilities (vSNF). We evaluated the factors associated with C. auris colonization among vSNF residents to inform prevention interventions.

METHODS

During 2016-2018, the NYS Department of Health conducted point prevalence surveys (PPS) to detect C. auris colonization among residents of vSNFs. In a case-control investigation, we defined a case as C. auris colonization in a resident, and identified up to 4 residents with negative swabs during the same PPS as controls. We abstracted data from medical records on patient facility transfers, antimicrobial use, and medical history.

RESULTS

We included 60 cases and 218 controls identified from 6 vSNFs. After controlling for potential confounders, the following characteristics were associated with C. auris colonization: being on a ventilator (adjusted odds ratio [aOR], 5.9; 95% confidence interval [CI], 2.3-15.4), receiving carbapenem antibiotics in the prior 90 days (aOR, 3.5; 95% CI, 1.6-7.6), having ≥1 acute care hospital visit in the prior 6 months (aOR, 4.2; 95% CI, 1.9-9.6), and receiving systemic fluconazole in the prior 90 days (aOR, 6.0; 95% CI, 1.6-22.6).

CONCLUSIONS

Targeted screening of patients in vSNFs with the above risk factors for C. auris can help identify colonized patients and facilitate the implementation of infection control measures. Antimicrobial stewardship may be an important factor in the prevention of C. auris colonization.

Investigating surface binding effects: antibacterial efficacy of bound 8-hydroxyquinoline against Staphylococcus aureus and Escherichia coli

AIMS

To investigate the binding of the antimicrobial compound 8-hydroxyquinoline (8HQ) to a material interface and to determine whether immobilization affects the antibacterial efficacy.

METHODS AND RESULTS

The 8HQ derivative 5-carboxy-8-hydroxyquinoline (5C8HQ) was attached to silica beads through amide bond coupling at the carboxyl moiety of 5C8HQ. Attachment of 5C8HQ was confirmed using a combination of mass spectrometry, thermogravimetric analysis, colorimetric testing and Soxhlet extraction. Computational modelling results indicated that this substitution did not compromise the active sites on the molecule, whereas other positions on the ring system could potentially inhibit antimicrobial activity. The antibacterial effect of 8HQ and the 5C8HQ-modified silica complex against Escherichia coli 15597 (ATCC^® 25922) and Staphylococcus aureus (ATCC 25923) was evaluated.

CONCLUSIONS

The test results show that the immobilized 8HQ continues to exhibit antibacterial activity, however, quantifying the efficacy compared to free 8HQ bears further investigation. The expected antibacterial mechanism requires that the metal chelation site of 8HQ be retained and available after attachment to a surface. The retention of antibacterial activity after surface bonding represents a novel mechanism of action not previously reported.

SIGNIFICANCE AND IMPACT OF THE STUDY

Recent changes in regulations due to environmental concerns prompted many companies and organizations to explore antimicrobial treatments that are chemically bound to the product. Chemically bonding biocidal compounds to a surface limits environmental release; however, molecular mechanisms that drive antibacterial activity when compounds are immobilized are limited. The results reported here demonstrate that the 8HQ reactive site retains antibacterial efficacy even after covalent attachment to a surface. This approach supersedes other antimicrobial treatments where the active component is gradually released from the material surface in order to elicit antimicrobial effects. This specific antibacterial activity of bound 8HQ represents a novel mechanism of action not previously reported, and a potential conduit to a new class of bound antimicrobial materials.

Reversible Silylium Transfer between P-H and Si-H Donors

The Mo=PR₂ π* orbital in a Mo phosphenium complex acts as acceptor in a new P^III -based Lewis superacid. This Lewis acid (LA) participates in electrophilic Si-H abstraction from E₃ SiH to give a Mo-bound secondary phosphine ligand, Mo-PR₂ H. The resulting Et₃ Si⁺ ion remains associated with the Mo complex, stabilized by η¹ -P-H donation, yet undergoes rapid exchange with an η¹ -Si-H adduct of free silane in solution. The equilibrium between these two adducts presents an opportunity to assess the role of this new LA in catalytic reactions of silanes: is the LA acting as a catalyst or as an initiator? Preliminary results suggest that a cycle including the Mo-bound phosphine-silylium adduct dominates in the catalytic hydrosilylation of acetophenone, relative to a putative cycle involving the silane-silylium adduct or "free" silylium.

Synthesis and Structure of Alkaline Earth Bis{hydrido-tris(3,5-diisopropyl-pyrazol-1-yl)borate} Complexes: Ae(TpiPr2)2 (Ae = Mg, Ca, Sr, Ba)

The synthesis and structural characterization of Ae(Tp^iPr2)₂ (Ae = Mg, Ca, Sr, Ba; Tp^iPr2 = hydrido-tris(3,5-diisopropyl-pyrazol-1-yl)borate) are reported. In the crystalline state, the alkaline earth metal centers are six-coordinate, even the small Mg²⁺ ion, with two κ³-N,N',N''-Tp^iPr2 ligands, disposed in a bent arrangement (B···Ae···B < 180°). However, contrary to the analogous Ln(Tp^iPr2)₂ (Ln = Sm, Eu, Tm, Yb) compounds, which all exhibit a bent-metallocene structure close to C_s symmetry, the Ae(Tp^iPr2)₂ compounds exhibit a greater structural variation. The smallest Mg(Tp^iPr2)₂ has crystallographically imposed C₂ symmetry, requiring both bending and twisting of the two Tp^iPr2 ligands, while with the similarly sized Ca²⁺ and Sr²⁺, the structures are back toward the bent-metallocene C_s symmetry. Despite the structural variations, the B···M···B bending angle follows a linear size-dependence for all divalent metal ions going from Mg²⁺ to Sm²⁺, decreasing with increasing metal ion size. The complex of the largest metal ion, Ba²⁺, forms an almost linear structure, B···Ba···B 167.5°. However, the "linearity" is not due to the compound approaching the linear metallocene-like geometry, but is the result of the pyrazolyl groups significantly tipping toward the metal center, approaching "side-on" coordination. An attempt to rationalize the observed structural variations is made.

Copper(i)-catalyzed regioselective Ullmann-type coupling of primary carbamates and 5-substituted-1,2,3-triiodobenzenes: facile synthesis of 2,3-diiodinated N-aryl carbamates

Mild, efficient, and unprecedented synthesis of 2,3-diiodinated N-aryl carbamates via highly regioselective Ullmann-type cross-coupling of 5-substituted-1,2,3-triiodobenzene and carbamate.

Insight into the Decomposition Mechanism of Donor-Acceptor Complexes of EH2 (E = Ge and Sn) and Access to Germanium Thin Films from Solution

Electron-donating N-heterocyclic carbenes (Lewis bases, LB) and electron-accepting Lewis acids (LA) have been used in tandem to yield donor-acceptor complexes of inorganic tetrelenes LB·EH₂·LA (E = Si, Ge, and Sn). Herein, we introduce the new germanium (II) dihydride adducts ImMe₂·GeH₂·BH₃ (ImMe₂ = (HCNMe)₂C:) and ImⁱPr₂Me₂·GeH₂·BH₃ (ImⁱPr₂Me₂ = (MeCNⁱPr)₂C:), with the former complex containing nearly 40 wt % germanium. The thermal release of bulk germanium from ImMe₂·GeH₂·BH₃ (and its deuterated isotopologue ImMe₂·GeD₂·BD₃) was examined in solution, and a combined kinetic and computational investigation was undertaken to probe the mechanism by which Ge is liberated. Moreover, the thermolysis of ImMe₂·GeH₂·BH₃ in solution cleanly affords conformal nanodimensional layers of germanium as thin films of variable thicknesses (20-70 nm) on silicon wafers. We also conducted a computational investigation into potential decomposition pathways for the germanium(II)- and tin(II)-dihydride complexes NHC·EH₂·BH₃ (NHC = [(HCNR)₂C:]; R = 2,6-ⁱPr₂C₆H₃ (Dipp), Me, and H; and E = Ge and Sn). Overall, this study introduces a mild and convenient solution-only protocol for the deposition of thin films of Ge, a widely used semiconductor in materials research and industry.

Clinical Sequelae Associated with Unresolved Tropical Splenomegaly in a Cohort of Recently Resettled Congolese Refugees in the United States-Multiple States, 2015-2018

Tropical splenomegaly is often associated with malaria and schistosomiasis. In 2014 and 2015, 145 Congolese refugees in western Uganda diagnosed with splenomegaly during predeparture medical examinations underwent enhanced screening for various etiologies. After anecdotal reports of unresolved splenomegaly and complications after U.S. arrival, patients were reassessed to describe long-term clinical progression after arrival in the United States. Post-arrival medical information was obtained through medical chart abstraction in collaboration with state health partners in nine participating states. We evaluated observed splenomegaly duration and associated clinical sequelae between 130 case patients from eastern Congo and 102 controls through adjusted hierarchical Poisson models, accounting for familial clustering. Of the 130 case patients, 95 (73.1%) had detectable splenomegaly after arrival. Of the 85 patients with records beyond 6 months, 45 (52.9%) had persistent splenomegaly, with a median persistence of 14.7 months (range 6.0-27.9 months). Of the 112 patients with available results, 65 (58.0%) patients had evidence of malaria infection, and the mean splenomegaly duration did not differ by Plasmodium species. Refugees with splenomegaly on arrival were 43% more likely to have anemia (adjusted relative risk [aRR]: 1.43, 95% CI: 1.04-1.97). Those with persistent splenomegaly were 60% more likely (adjusted relative risk [aRR]: 1.60, 95% CI: 1.15-2.23) to have a hematologic abnormality, particularly thrombocytopenia (aRR: 5.53, 95% CI: 1.73-17.62), and elevated alkaline phosphatase (aRR: 1.57, 95% CI: 1.03-2.40). Many patients experienced persistent splenomegaly, contradicting literature describing resolution after treatment and removal from an endemic setting. Other possible etiologies should be investigated and effective treatment, beyond treatment for malaria and schistosomiasis, explored.

Mild, Efficient, and Highly Regioselective Synthesis of 2,6-Diiodobenzaldehyde Derivatives

An efficient and versatile synthesis of 2,6-diiodobenzaldehydes via highly regioselective metal–iodine exchange (MIE) of 5-substituted 1,2,3-triiodobenzenes is reported. The nature of substituents (R) on the phenyl has a large influence on the reactivity of reaction but not on the regioselectivity. The regioselectivity of the MIE can be controlled by the use of ethyl formate as a formylating agent providing only the internal benzaldehyde derivatives in excellent site-selectivity. The best reactivity and the highest isolated yields were furnished with products bearing electron-rich substituents. Several chemical transformations of the target compound as a valuable precursor in synthesis were also demonstrated providing the desired derivatives in good isolated yields. This report discloses a protocol for the synthesis of 2,6-diiodobenzaldehyde derivatives that is scalable, general in scope, and indeed difficult to be made by other means.

The design of a line velocity interferometer for any reflector for inertial confinement experiments on the Z-machine

A line VISAR (Velocity Interferometer System for Any Reflector) has been designed and commissioned at the Sandia National Laboratory's Z-machine. The instrument consists of an F/2 collection system, beam transport, and an interferometer table that contains two Mach-Zehnder type interferometers and an eight channel Gated Optical Imaging (GOI) system. The VISAR probe laser operates at the 532 nm wavelength, and the GOI bandpass is 540-600 nm. The output of each interferometer is passed to an optical streak camera with four selectable sweep speeds. The system is designed with three interchangeable optics modules to select a full field of view of 1 mm, 2 mm, or 4 mm. The optical beam transport system connects the target image plane to the interferometers and the gated optical imagers. The target is integrated into a sacrificial final optics assembly that is integral to the transport beamline.

Linking Low-Coordinate Ge(II) Centers via Bridging Anionic N-Heterocyclic Olefin Ligands

We introduce a large-scale synthesis of a sterically encumbered N-heterocyclic olefin (NHO) and illustrate the ability of its deprotonated form to act as an anionic four-electron bridging ligand. The resulting multicenter donating ability has been used to link two low oxidation state Ge(II) centers in close proximity, leading to bridging Ge-Cl-Ge and Ge-H-Ge bonding environments supported by Ge₂C₂ heterocyclic manifolds. Reduction of a dimeric [RGeCl]₂ species (R = anionic NHO, [(MeCNDipp)₂C═CH]^-; Dipp = 2,6-ⁱPr₂C₆H₃) did not give the expected acyclic RGeGeR analogue of an alkyne, but rather ligand migration/disproportionation transpired to yield the known diorganogermylene R₂Ge and Ge metal. This process was examined computationally, and the ability of the reported anionic NHO to undergo atom migration chemistry contrasts with what is typically found with bulky monoanionic ligands (such as terphenyl ligands).

Regioselective synthesis of ortho-iodobiphenylboronic acid derivatives: a superior catalyst for carboxylic acid activation

Efficient and versatile synthesis of ortho-iodobiphenylboronic acids with remarkable catalytic and microbial activities.

Challenges and Strategies for Educational Virtual Reality

Virtual reality (VR) is a rich visualization and analytic platform that furthers the library’s mission of providing access to all forms of information and supporting pedagogy and scholarship across disciplines. Academic libraries are increasingly adopting VR technology for a variety of research and teaching purposes, which include providing enhanced access to digital collections, offering new research tools, and constructing new immersive learning environments for students. This trend suggests that positive technological innovation is flourishing in libraries, but there remains a lack of clear guidance in the library community on how to introduce these technologies in effective ways and make them sustainable within different types of institutions. In June 2018, the University of Oklahoma hosted the second of three forums on the use of 3D and VR for visualization and analysis in academic libraries, as part of the project Developing Library Strategy for 3D and Virtual Reality Collection Development and Reuse(LIB3DVR), funded by a grant from the Institute of Museum and Library Services. This qualitative study invited experts from a range of disciplines and sectors to identify common challenges in the visualization and analysis of 3D data, and the management of VR programs, for the purpose of developing a national library strategy.

LB16. The Role of Adults in the Measles Outbreak in New York State Outside of New York City, 2018–2019

Background

The United States is experiencing the largest measles outbreak since elimination was declared in 2000, with the majority of cases in NYS reported in undervaccinated communities. The objective of this evaluation was to describe adult measles cases in the NYS measles outbreak outside of New York City (NYC).

Methods

We included all confirmed cases aged ≥18 years in NYS residents (excluding NYC) during October 1, 2018–July 25, 2019 that met the CSTE measles case definition. We defined measles cases attributable to adults as the sum of measles cases among adults and children who contracted disease directly from adults.

Results

Among 371 confirmed measles cases, the median age was 5.5 years (range: 1 day to 64 years); 79 (21%) were in adults, 4 (5%) of whom were born before 1957 (3 unvaccinated and 1 with unknown vaccine status). Among the 75 cases born during or after 1957, 65 (87%) were unvaccinated or had unknown vaccine status, while 3 had one dose and 7 had 2 doses of measles vaccine. Notably, 5 of 11 internationally imported measles cases were adults, and all were unvaccinated or had unknown vaccine status. During the first month of the outbreak, 26 of the 51 (51%) cases were attributable to adults; of the 26, 15 (58%) were in adults and 11 (42%) were in children who acquired infection from adults (Figure 3).

Conclusion

The majority of measles cases occurred in unvaccinated children emphasizing the importance of ongoing and focused efforts on pediatric vaccination. However, measles cases in unvaccinated adults played an important role in both importations and disease transmission early in the outbreak. These data strongly support current recommendations of 1 dose of measles, mumps, rubella vaccine (MMR) for most adults and 2 doses of MMR for adults traveling internationally and at high-risk such as those in outbreak areas, as determined by local/state public health.

Disclosures

Kirsten St. George, MAppSc, PhD, Akonni Biosystems (Other Financial or Material Support), ThermoFisher (Grant/Research Support), Zeptometrix (Other Financial or Material Support, royalty generating collaborative agreement). .