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Enteroviruses frequently result in respiratory and gastrointestinal illness; however, multiple subtypes, including poliovirus, can cause severe neurologic disease. Recent biennial increases (i.e., 2014, 2016, and 2018) in cases of non-polio acute flaccid paralysis have led to speculations that other enteroviruses, specifically enterovirus D68 (EV-D68), are emerging to fill the niche that was left from poliovirus eradication. A cluster of 11 suspect cases of pediatric acute flaccid myelitis (AFM) was identified in 2016 in Phoenix, AZ. Multiple genomic analyses identified the presence of EV-D68 in the majority of clinical AFM cases. Beyond limited detection of herpesvirus, no other likely etiologies were found in the cluster. These findings strengthen the likelihood that EV-D68 is a cause of AFM and show that the rapid molecular assays developed for this study are useful for investigations of AFM and EV-D68.

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Background Short-term rehabilitation units present unique infection control challenges due to high turnover and medically complex residents. In June 2021, Maricopa County Department of Public Health (MCDPH) was notified of a SARS-CoV-2 Delta outbreak in a skilled nursing facility short-term rehabilitation unit. We describe the outbreak and assess vaccine effectiveness (VE). Methods Facility electronic medical records were reviewed for residents who spent >1 night on the affected unit between June 10–July 23, 2021, to collect demographics, SARS-CoV-2 test results, underlying medical conditions, vaccination status, and clinical outcomes. COVID-19 VE estimates using Cox proportional hazards models were calculated. Results Forty (37%) of 109 short-stay rehabilitation unit residents who met inclusion criteria tested positive for SARS-CoV-2. SARS-CoV-2 positive case-patients were mostly male (58%) and white (78%) with a median age of 65 (range: 27-92) years; 11 (27%) were immunocompromised. Of residents, 39% (10 cases; 32 non-cases) received 2-doses and 9% (4 cases, 6 non-cases) received 1-dose of mRNA vaccine. Among non-immunocompromised residents, adjusted 2-dose primary-series mRNA VE against symptomatic infection was 80% (95% CI: 15, 95). More cases were hospitalized (33%) or died (38%) than non-cases (10% hospitalized; 16% died). Conclusions In this large SARS-CoV-2 Delta outbreak in a high-turnover short term rehabilitation unit, a low vaccination rate and medically complex resident population were noted alongside severe outcomes. VE of 2-dose primary-series mRNA vaccine against symptomatic infection was the highest in non-immunocompromised residents. Health departments can use vaccine coverage data to prioritize facilities for assistance in preventing outbreaks.

Cervical cancer is the second most common malignancy and a leading killer among women worldwide. Seventy percent of these cervical cancers are known to be caused by Human Papilloma Virus, which is transmitted primarily by sexual contact. The use of Human Papilloma Virus prophylactic vaccine among young adolescents, who have not been previously exposed to the infection, as primary prevention holds most promise for the prevention of this cervical cancer. Each year 80% of the 274,000 deaths caused by cervical cancer occur in developing nations like Nepal. Largest promise of this vaccine is in such countries where screening program is difficult to implement and maintain. However this also raises concerns and debates about the enduring effectiveness and the long term side effects of the vaccine, which are yet unknown. Garnering public trust and public acceptance is key to the success of any public health intervention. More research on the long term safety and efficacy on Human Papilloma Virus vaccine and dissemination of these findings is recommended to increase the acceptance of the program before making it a state mandate.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):167-171.