Race and ethnicity as risk factors for colonization and infection with key bacterial pathogens: a scoping review.

Background: Racial and ethnic disparities in infectious disease burden have been reported in the USA and globally, most recently for COVID-19. It remains unclear whether such disparities also exist for priority bacterial pathogens that are increasingly antibiotic-resistant. We conducted a scoping review to summarize published studies that report on colonization or community-acquired infection with pathogens among different races and ethnicities. Methods: We conducted an electronic literature search of MEDLINE®, Daily, Global Health, Embase, Cochrane Central, and Web of Science from inception to January 2022 for eligible observational studies. Abstracts and full-text publications were screened in duplicate for studies that reported data for race or ethnicity for at least one of the pathogens of interest. Results: Fifty-four observational studies in 59 publications met our inclusion criteria. Studies reported results for Enterobacterales, Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus, and were conducted in Australia, Brazil, Israel, New Zealand, and USA. USA studies most often examined Black and Hispanic minority groups with studies regularly reporting a higher risk of these pathogens in Black persons and mixed results for Hispanic persons. Ethnic minority groups (e.g. Bedouins in Israel, Aboriginals in Australia) were often reported to be at a higher risk in other countries. Conclusion: Sufficient evidence was identified in this scoping review justifying future systematic reviews and meta-analyses evaluating the relationship between community-acquired pathogens and race and ethnicity. However, we noted that only a fraction of studies reported data stratified by race and ethnicity, highlighting a substantial gap in the literature.

Socioeconomic status and the risk for colonization or infection with priority bacterial pathogens: a global evidence map.

Low socioeconomic status (SES) is thought to exacerbate risks for bacterial infections, but global evidence for this relationship has not been synthesized. We systematically reviewed the literature for studies describing participants' SES and their risk of colonization or community-acquired infection with priority bacterial pathogens. Fifty studies from 14 countries reported outcomes by participants' education, healthcare access, income, residential crowding, SES deprivation score, urbanicity, or sanitation access. Low educational attainment, lower than average income levels, lack of healthcare access, residential crowding, and high deprivation were generally associated with higher risks of colonization or infection. There is limited research on these outcomes in low- and middle-income countries (LMICs) and conflicting findings regarding the effects of urbanicity. Only a fraction of studies investigating pathogen colonization and infection reported data stratified by participants' SES. Future studies should report stratified data to improve understanding of the complex interplay between SES and health, especially in LMICs.

Firefighter Overexertion: A Continuing Problem Found in an Analysis of Non-Fatal Injury Among Career Firefighters.

Traditionally, safety-related research on firefighting has focused on fires and fireground smoke as the primary source of non-fatal firefighter injury. However, recent research has found that overexertion and musculoskeletal disorders may be the primary source of firefighter injury. This study aimed to provide an update on injury occurrence among career firefighters. Injury data were collected over a two-year period from two large metropolitan fire departments in the U.S. Injury data were categorized based on the Bureau of Labor Statistics' Occupational Injury and Illness Classification System. Cross-tabulations and Chi-square tests were used to determine the primary causes of injury, as well as the injury region. Between the two fire departments, there were 914 firefighters included in the analysis. The median age was 40.7 years old with those aged 40-49 as the largest age group for injury cases (38.3%). The most frequently reported cause of injury was 'overexertion and bodily reaction' (n = 494; 54.1%). The most reported injury region was in 'multiple body parts' (n = 331; 36.3%). To prevent subsequent musculoskeletal disorders that may arise due to overexertion, initiatives that promote enhanced fitness and ergonomics based on an analysis of the physical demands of firefighting are suggested.

Update on Ebola Treatment Center Costs and Sustainability, United States, 2019.

We surveyed 56 Ebola treatment centers (ETCs) in the United States and identified costs incurred since 2014 ($1.76 million/ETC) and sustainability strategies. ETCs reported heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.

An update on US Ebola treatment center personnel management and training.

BACKGROUND: In 2014, 56 US hospitals were designated as Ebola treatment centers (ETCs). ETCs had minimum augmented capability requirements for Ebola virus disease care, including for staffing and training. We sought to identify current ETC staffing challenges and frequency of staff retraining. METHODS: In May 2019, an electronic survey was distributed to representatives of the 56 ETCs. RESULTS: Sixty-six percent (37/56) of ETCs responded. Registered nurses comprised the majority of ETC staff. All responding units required orientation training (average = 15.21 hours) and all but one required retraining. Among the top challenges that ETCs reported to maintaining high-level isolation capabilities were staff training time, staff recruitment, staff retention, and training costs. DISCUSSION: Five years after ETC designation, units face staffing challenges. Research is lacking on the effective number of hours and optimal frequency of staff training. ETCs reported smaller staffing teams compared to our 2016 assessment, but team composition remains similar. As units continue to maintain capabilities with decreasing external support and attention, the need for retraining must be balanced with logistical constraints and competing demands for staff time. CONCLUSIONS: Our study shows that US preparedness capabilities are reduced. More research, support, and funding are needed to sustain the unique knowledge and proficiency acquired by ETC teams to ensure domestic preparedness for highly hazardous communicable diseases.

U.S. Medical Examiner/Coroner capability to handle highly infectious decedents.

In the United States of America, Medical Examiners and Coroners (ME/Cs) investigate approximately 20% of all deaths. Unexpected deaths, such as those occurring due to a deceased person under investigation for a highly infectious disease, are likely to fall under ME/C jurisdiction, thereby placing the ME/C and other morgue personnel at increased risk of contracting an occupationally acquired infection. This survey of U.S. ME/Cs' capabilities to address highly infectious decedents aimed to determine opportunities for improvement at ME/C facilities serving a state or metropolitan area. Data for this study was gathered via an electronic survey. Of the 177 electronic surveys that were distributed, the overall response rate was N = 108 (61%), with 99 of those 108 respondents completing all the questions within the survey. At least one ME/C responded from 47 of 50 states, and the District of Columbia. Select results were: less than half of respondents (44%) stated that their office had been involved in handling a suspected or confirmed highly infectious remains case and responses indicated medical examiners. Additionally, ME/C altered their personal protective equipment based on suspected versus confirmed highly infectious remains rather than taking an all-hazards approach. Standard operating procedures or guidelines should be updated to take an all-hazards approach, best-practices on handling highly infectious remains could be integrated into a standardized education, and evidence-based information on appropriate personal protective equipment selection could be incorporated into a widely disseminated learning module for addressing suspected or confirmed highly infectious remains, as those areas were revealed to be currently lacking.