Geographic Distribution of Synthetic Cannabinoid Exposures Reported to Texas Poison Centers

Background: Synthetic cannabinoids have recently gained popularity as recreational drugs because they provide a marijuana-like high and cannot be detected in typical urine drug screens. However, the use of synthetic cannabinoids may result in a variety of adverse effects. Objectives: The intent of this investigation was to determine whether synthetic cannabinoid exposures in Texas demonstrated any geographic variation. Methods: A total of 1037 synthetic cannabinoid exposures reported to Texas poison centers during 2010–2011 were identified and the county and Texas Public Health Region (PHR) where the call originated from ascertained. The distribution of exposures by county and PHR was determined. Results: Synthetic cannabinoid exposures were reported in 124 of the 254 Texas counties (mean exposures per county 4.1, range 0–179). The exposure rate among the 11 PHRs varied from 2.79 to 7.14 per 100,000 population. The rate was 4.02 in urban counties and 4.90 in rural counties. Conclusion: Synthetic cannabinoid exposures reported to Texas poison centers varied by geographic region. The rate tended to be higher in rural counties. Scientific Significance: Such information may be useful when attempting to target education and prevention activities.     

Characterization of intentional-abuse venlafaxine exposures reported to poison control centers in the United States

Background: Venlafaxine use to achieve an amphetamine-like high has been described but data regarding the epidemiology and clinical effects are sparse. Objectives: Describe the prevalence and toxicity of venlafaxine abuse reported to US poison control centers. Methods: This was a retrospective review of venlafaxine exposures reported to the National Poison Data System (NPDS) from 2000 to 2016. Inclusion criteria were: age 12 years and older, reason for exposure intentional-abuse, and either single-substance exposure or venlafaxine was the first substance. The primary outcome was prevalence of intentional-abuse of venlafaxine. Secondary outcomes characterized demographics, geographic distribution, toxicity, and outcomes. Results: Intentional-abuse accounted for 752 of 85,621 venlafaxine exposures. Overall prevalence was 87.8 intentional-abuse exposures/10,000 venlafaxine exposures reported to NPDS (range, 59.3–117.6/10,000). Prevalence decreased from 107/10,000 in 2000 to 59.3/10,000 in 2016. Median age was 23 years and 50% were female. Primary route was ingestion (90.8%) with 4.7% using venlafaxine via inhalation/intranasal insufflation, and 3.7% both routes. There were 227 venlafaxine-only exposures; 54.0% were treated/released from the emergency department, 20% were admitted for medical management, 9.0% to a psychiatric facility, and 17.0% managed at home. Known medical outcomes for single-substance exposures were: no effect (24.0%), minor (39.0%), moderate (33.0%), and major (4.0%); no deaths occurred. Most frequent clinical effects were tachycardia (33.9%), drowsiness (20.7%), and agitation (11.5%). Conclusion: The prevalence of venlafaxine abuse reported to poison control centers has decreased. Medical outcomes are usually not serious. Clinicians should be aware that non-medical use is possible but infrequently reported to poison control centers.     

Intentional Coricidin Product Exposures among Illinois Adolescents

Objectives: We sought to describe the demographics and trends of Coricidin product abuse in children in Illinois and to calculate an approximate total charge to the health-care system. Methods: In this retrospective database review, we identified 652 cases of intentional exposure to Coricidin products among children <18 years old in the Illinois Poison Center database from 2001 to 2006. Demographic, historical, clinical, and outcome data were recorded. Results: The mean (standard deviation) age was 15.7 (1.58) years. A significant increase in exposures occurred during the study period which showed a cyclic nature with peaks in the fall months. Of the patients with disposition data available, 28.6% were admitted to a critical care unit, 15.2% to a noncritical care hospital unit, 6.3% were admitted for inpatient psychiatric care, and 46.4% were evaluated in the emergency department and discharged home. Moderate or major outcomes were reported in 42.7% of cases in which data were available. No deaths were reported. The total approximate hospital charge was $2,119,881.90 or $353,313.65/year. Conclusions: Intentional abuse of Coricidin products reported to the poison center occurred primarily among adolescents and was often associated with significant short-term clinical effects and a clear financial burden to the health-care system. Scientific Significance: This investigation demonstrates that Coricidin product abuse continues to be a problem particularly among adolescents. Parents and clinicians need to continue to be aware of these substances as drugs of abuse and curbing sales to adolescents should be considered.     

Late-onset respiratory distress after inhalation of laundry detergent

Accidental poisoning with household cleaning products can pose significant risks to children. Exposure to granular laundry detergents accounts for a number of calls each year to poison control centers, though few of these exposures result in hospitalization. While caustic gastrointestinal injury resulting from ingestion of these highly alkaline cleaning agents is well-recognized, few reports address the potential damage to the respiratory tract that can occur following ingestion or inhalation of granular laundry detergent. We present a previously healthy 1-year-old who presented to the emergency department with Late-onset stridor and increased work of breathing following presumed inhalation of granular laundry detergent. Parents, primary care providers, and emergency department physicians need to be aware of the potential toxicity of these widely used household products.     

Self-reported use of novel psychoactive substances among attendees of electronic dance music venues

Background: Novel psychoactive substances (NPSs) continue to emerge in the United States and worldwide. Few epidemiological studies have examined the prevalence and correlates of use. Objective: We examined the extent of NPS use in a high-risk population—attendees of electronic dance music (EDM) parties at nightclubs and festivals. Methods: We surveyed 682 adults (age 18–25) entering EDM events at nightclubs and festivals in New York City (NYC) in 2015. A variation of time–space sampling was used. We examined the prevalence of self-reported use of 196 NPS and correlates of any NPS use. Results: Over a third (35.1%) of participants reported lifetime use of any NPS. Self-reported use of synthetic cannabinoids was most prevalent (16.3%), followed by psychedelic phenethylamines (14.7%; 2C series: 10.3%, 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine [NBOMe] series: 9.0%, Dox series: 3.5%), synthetic cathinones (“bath salts”, 6.9%), other psychedelics (6.6%), tryptamines (5.1%), and dissociatives (4.3%). 2C-I was the most prevalent 2C series drug (5.1%); methylone was the most prevalent synthetic cathinone (3.3%), 2-MeO-ketamine was the most prevalent dissociative (3.7%), and 1P-lysergic acid diethylamide (LSD) (2.9%) was the most prevalent non-phenethylamine psychedelic. Risk factors for NPS use included Ecstasy/MDMA/Molly, LSD, and ketamine use; identifying as bisexual (compared to heterosexual), reporting higher frequency of nightclub/festival attendance, and being surveyed outside of a festival (compared to those surveyed outside of nightclubs). Discussion: NPS use is prevalent in the nightclub and festival scenes in NYC. Since individuals in these scenes—especially frequent attendees—are at high risk for use, prevention and harm reduction services need to be geared toward this population.     

A profile of calls to a poison information center regarding older adults

OBJECTIVES: The authors sought to examine the nature of calls to poison information centers by adults ages 50 and over. METHODS: The authors used data from the national Toxic Exposure Surveillance System and conducted a retrospective review of all cases reported to an American Association of Poison Control Centers Certified Regional Poison Information Center in 1998 and 1999 (N = 6,365). RESULTS: The results indicated that females' poison experiences were more likely the result of therapeutic error, adverse drug reactions, ingestions, and the acute-on-chronic class. The authors found that older age was inversely associated with acute class, suspected suicide, food poisoning, and inhalation and dermal exposures. DISCUSSION: Older adults are the greatest consumers of over-the-counter drugs, take multiple medications for various medical conditions, and are experiencing biological changes that affect drug metabolism. Older women may be at especially high risk because of high drug use. Poison prevention education should target older adults.     

Early Daycare Attendance Increase the Risk for Respiratory Infections and Asthma of Children

Objectives: To study the impact of daycare attendance on airways infections and “allergic” symptoms of children aged 1–8 years in Northeast Texas. Methods: Self-administrated questionnaires were distributed to parents through Women, Infants and Children offices, daycare centers, elementary schools, clinic centers, hospitals, and churches. The health outcomes consisted of “allergic” symptoms, and respiratory tract disorders. Questions on child care included; type of daycare settings (proxy for the number of children in daycare), time spent at daycare centers per week, and age of entry to a daycare center. Results: A total of 3766 children participated in this study, giving a response rate of 71%. Daycare attendance was associated with more frequent respiratory tract infections and “allergic” symptoms, compared to home care. A dose–response relationship between time spent at daycare centers and prevalence of respiratory tract disorders and asthma and allergies was observed. Earlier age exposure at daycare centers was a risk factor for rhinitis up to 7–8 years. Conclusions: Daycare attendance had a substantial negative influence on health status of children aged 1–8 years in Northeast Texas.     

Agricultural avermectins: an uncommon but potentially fatal cause of pesticide poisoning.

STUDY OBJECTIVE: Avermectins have been used in the control of parasites and insects; however, human data concerning poisoning are lacking. This study investigated the clinical spectrum of avermectin poisoning. METHODS: A retrospective study was conducted to evaluate patients with avermectin poisoning reported to a poison center from September 1993 through December 1997. RESULTS: Eighteen patients with abamectin (Agri-Mek; 2% wt/wt abamectin) exposure and 1 with ivermectin (Ivomec; 1% wt/vol ivermectin) ingestion were identified. There were 14 male and 5 female patients, ranging in age from 15 to 83 years. Most patients were exposed as a result of attempted suicide (14). Oral ingestion (15) was the most common route of exposure. Four patients were asymptomatic, and 8 had minor symptoms after a mean ingestion of 23 mg/kg abamectin (4.2 to 67 mg/kg), or after dermal and inhalation contact. Seven patients manifested severe symptoms, such as coma (7), aspiration with respiratory failure (4), and hypotension (3), after a mean ingestion of 100.7 mg/kg avermectin (15.4 mg/kg for ivermectin and 114.9 mg/kg for abamectin). All 7 patients received intensive supportive care; 1 patient died 18 days later as a result of multiple organ failure. CONCLUSION: Ingestion of a large dose of avermectin may be associated with life-threatening coma, hypotension, and subsequent aspiration.     

Electrocardiographic changes associated with β-blocker toxicity

Study objective: We sought to characterize the ECG changes associated with symptomatic β-blocker overdose. Methods: The study population consisted of a prospective cohort of patients reporting to 2 regional poison centers with β-blocker overdose. Each patient received an ECG on presentation and a structured follow-up. The inclusion criteria for symptomatic overdose included heart rate of less than 60 beats/min or systolic blood pressure of less than 90 mm Hg; symptoms consistent with decreased end-organ perfusion; therapeutic intervention with cardioactive medication; and corroboration by 2 of the authors that this was a clear-cut case of symptomatic β-blocker overdose with cardiovascular toxicity. Exclusion criteria included cardioactive coingestants, age younger than 6 years, and no available ECG. Results: Of 167 patients, 13 were determined to have symptomatic exposures. First-degree heart block (>200 ms) was the most common ECG finding (10/12) and also had the greatest likelihood ratio (5.31) when comparing those with symptomatic exposures with those with asymptomatic exposures. Comparing the asymptomatic with the symptomatic groups, the mean PR interval was 167 ms (95% confidence interval [CI] 162 to 171 ms) versus 216 ms (95% CI 193 to 238 ms), the mean QRS interval was 89 ms (95% CI 87 to 91 ms) versus 112 ms (95% CI 92 to 132 ms), the mean QTc interval was 422 ms (95% CI 417 to 428) versus 462 ms (95% CI 434 to 490 ms), and the mean heart rate was 72 beats/min (95% CI 69 to 74 beats/min) versus 66 beats/min (95% CI 59 to 73 beats/min). Two cases of symptomatic acebutolol exposure appeared unique by demonstrating disproportionate prolongation of the QTc interval, an RaVR height of 3 mm or greater, and associated ventricular tachydysrhythmia. Conclusion: The majority of clinically significant β-blocker intoxications demonstrate negative dromotropic effects on ECG. Several ECG differences in acebutolol intoxication might reflect unique pathophysiologic processes relative to other β-blockers. [Ann Emerg Med. 2002;40:603-610.]     

Fatal overdose from synthetic cannabinoids and cathinones in Japan: demographics and autopsy findings

ABSTRACT

Background: Sixty-one autopsy cases involving cathinones and/or cannabinoids (synthetic cathinones/cannabinoids) use have been reported. However, little is known about the demographics and autopsy findings in fatal synthetic cathinones/cannabinoids users. Objectives: To elucidate demographic and autopsy findings (i.e. major organ pathology and causes of death) in synthetic cathinones/cannabinoids cases. Methods: We reviewed forensic autopsy reports in Department of Legal Medicine of Tokyo Women’s Medical University (Tokyo, Japan) between 2011 and 2015 (a total of 359). We compared demographic and autopsy findings between synthetic cathinones/cannabinoids and methamphetamine cases (as control subjects). Results: There were 12 synthetic cathinones/cannabinoids cases and 10 methamphetamine cases. Synthetic cathinones/cannabinoids users were significantly younger than methamphetamine users (p < 0.01), and there were no cases that used both synthetic cathinones/cannabinoids and methamphetamine. Acute intoxication and cardiac ischemia were the two most prominent causes of death in both synthetic cathinones/cannabinoids users and methamphetamine users. Excited delirium syndrome and pulmonary aspiration were found only in synthetic cathinones/cannabinoids cases. Conclusions: The populations of synthetic cathinones/cannabinoids and methamphetamine users who died of an overdose are different in Japan. Acute intoxication, cardiac ischemia, excited delirium syndrome, pulmonary aspiration, and drowning are the major autopsy findings in synthetic cathinones/cannabinoids-related death. Clinicians shuld be aware of these potentially fatal complications in the medical management of synthetic cathinones/cannabinoids users.     

Association between mental distress,gastrointestinal symptoms,and health-care utilization in functional dyspepsia: a prospective 7-year follow-up study

Abstract

Objective. The association between psychosocial factors and gastrointestinal symptoms is unclear. It has been proposed that they simply drive health-care seeking of patients. We therefore aimed to study whether mental distress would increase health-care utilization in functional dyspepsia (FD). Methods. 171 primary care FD patients completed questionnaires screening gastrointestinal symptoms, mental distress, and health-care utilization between 1993 and 2000. These included the Bowel Disease Questionnaire and 12-item General Health Questionnaire. The patients' medical records were reviewed in primary care centers, Kuopio University Hospital, local hospitals, and private clinics. Results. The majority of patients revisited their general practitioner (GP), and most of them were prescribed antisecretory medication. Repeated gastroscopy and lower gastrointestinal endoscopy were performed in 26% of the patients. A radiological reinvestigation, usually upper abdominal ultrasound, was performed in one-third. Nine percent were hospitalized due to gastrointestinal reasons. A single additional bowel symptom increased the probability of repeated endoscopy by 19%, a visit to the GP by 19%, and an inpatient period by 51%. Neither an increase in the dyspepsia score nor the presence of mental distress or suspicion of serious illness increased the probability of health-care utilization. Conclusion. There is no association between mental distress and health-care utilization for gastrointestinal symptoms.     

Characteristics associated with synthetic cannabinoid use among patients treated in a public psychiatric emergency setting

Background: Growing evidence of adverse outcomes following synthetic cannabinoid use has engendered interest into populations at risk. The existing literature reports that synthetic cannabinoid use is predominant among young, white males. However, reports from local Departments of Health have found contrary evidence, showing that synthetic cannabinoid use is prevalent in populations other than those of young, white men. Objectives: This study sought to examine sociodemographic characteristics associated with self-reported synthetic cannabinoid use among a clinical psychiatric population within a public hospital in New York City. Methods: A cross-sectional medical record review was conducted on synthetic cannabinoid users and non-users in an emergency psychiatric setting. A total of 948 patients who presented at the emergency psychiatric setting in 2014 were included in this sample, 110 (11.6%) of whom were synthetic cannabinoid users. Logistic regressions were used to determine the sociodemographic correlates of synthetic cannabinoid use. Results: The most prominent correlate of synthetic cannabinoid use was homelessness/residing in a shelter during time of treatment (AOR = 17.77, 95% CI = 9.74–32.5). Male (AOR = 5.37, 95% CI = 2.04–14.1), non-white (AOR = 2.74, 95% CI = 1.36–5.54), and younger age (AOR = .961, 95% CI = .940–.980) were also significant correlates of synthetic cannabinoid use. Conclusion: Synthetic cannabinoid use among the homeless and mentally ill is a growing public health concern, representing a population with unique clinical and social needs. Areas and populations with high rates of homelessness should be targeted for synthetic cannabinoid prevention and treatment efforts, particularly in urban and racial/ethnic minority communities.     

Mushroom poisoning: a study on circumstances of exposure and patterns of toxicity

BackgroundPicking wild mushrooms is a popular pastime in Switzerland. Correct identification of the species is difficult for laypersons. Ingestion of toxic mushrooms may result in serious toxicity, including death. The aim of the study is to analyze and describe the circumstances of exposure to mushrooms, and to define the clinical relevance of mushroom poisoning for humans in Central Europe.Materials and methodsWe performed a retrospective case study and analyzed all inquiries concerning human exposures to mushrooms (n = 5638, 1.2% of all inquiries) which were reported to the Swiss Toxicological Information Centre between January 1995 and December 2009.ResultsThe most frequent reason for contacting the poison center in cases of adult exposure was toxicity resulting from edible species. Pediatric exposure predominantly occurred from mushrooms found around the home. Severe symptoms have not only been observed after ingestion of non-amatoxin-containing toxic mushrooms, i.e. Boletus sp. and Cortinarius sp., but also after meals of edible species. The mortality of confirmed amatoxin poisonings was high (5/32) compared to other reports.ConclusionsInquiries regarding mushroom poisoning were a relatively infrequent reason for contacting the poison center. Nevertheless, accidental ingestion of toxic mushrooms can be responsible for severe or fatal poisonings. Although pediatric exposure to mushrooms found around the home has not led to serious toxicity in this study, prevention of exposure is warranted. Inspection of wild mushrooms by a certified mushroom expert or a mycologist seems to be a safe procedure which should be recommended.     

University students’ attributions for abstinence from synthetic cannabinoids and synthetic cathinones

Background: Synthetic cannabinoids and synthetic cathinones are two increasingly available and potentially dangerous classes of substances. Objective: We designed this study to test whether university students rated the influence of different types of reasons for abstaining differently as a function of type of drug (synthetic cannabinoids vs. synthetic cathinones) and gender (male vs. female). Method: Using a web-based survey, 176 male and 437 female undergraduate university students rated the degree to which each of 42 reasons for not taking drugs influenced their abstinence from those two classes of substances. Results: Exploratory factor analyses suggested four subscales of reasons applicable to both substances: (1) psychological and behavioral impairment, (2) somatic and physiological concerns, (3) social approval and self-image concerns, and (4) insufficient knowledge and limited access. Both men and women rated all four subscales of reasons as having more influence on their abstinence from synthetic cathinones than synthetic cannabinoids, and women rated each subscale except somatic and physiological concerns as having more influence than did men. Conclusions: Although there were main effects for type of drug, because students typically reported the same types of reasons as being more or less influential for both classes of substances, prevention interventions could focus simultaneously on reasons to avoid or delay use of both types of substances.     

Using poison center data for national public health surveillance for chemical and poison exposure and associated illness

The National Poison Data System (NPDS) is a national near-real-time surveillance system that improves situational awareness for chemical and poison exposures, according to data from US poison centers. NPDS is the successor to the Toxic Exposure Surveillance System. The Centers for Disease Control and Prevention (CDC) use these data, which are owned and managed by the American Association of Poison Control Centers, to improve public health surveillance for chemical and poison exposures and associated illness, identify early markers of chemical events, and enhance situational awareness during outbreaks. Information recorded in this database is from self-reported calls from the public or health care professionals. In 2009, NPDS detected 22 events of public health significance and CDC used the system to monitor several multistate outbreaks. One of the limitations of the system is that exposures do not necessarily represent a poisoning. Incorporating NPDS data into the public health surveillance network and subsequently using NPDS to rapidly identify chemical and poison exposures exemplifies the importance of the poison centers and NPDS to public health surveillance. This integration provides the opportunity to improve the public health response to chemical and poison exposures, minimizes morbidity and mortality, and serves as an important step forward in surveillance technology and integration.     

A pilot randomized trial of school-based administration of inhaled corticosteroids for at-risk children with asthma

Objective: To investigate whether high adherence to inhaled corticosteroids (ICS) among disadvantaged urban public school children on public insurance with persistent asthma is achievable by having school nurses administer morning doses on each day that school is in session. Design/methods: This was a pilot prospective randomized clinical trial of home versus school nurse-administered ICS among children on Medicaid enrolled in grades K-8. The primary outcome was the proportion of expected morning doses of ICS given to the intervention group in school over the 60-day treatment period. Secondary outcomes included the relative proportions of expected doses (morning, evening, and total), asthma-related morbidity, quality of life, and health-care utilization. Results: A total of 46 patients were enrolled (mean age 8.21 ± 2.45; 56.5% male; 91.3% non-Hispanic, African-Americans), and follow-up data were available for 44/46 (95.7%) patients. The groups did not differ in age, gender, race/ethnicity, or asthma severity. The intervention group received 91.7% of expected morning doses of ICS at school over the 60-day treatment period (95% CI [87.7, 95.5]). Intervention patients reported significantly less functional limitation (42.9% vs. 73.9%, p = 0.04), adjustment to family life (23.8% vs. 56.5%, p = 0.03), and sleep loss (1.7 vs. 4.1 nights in last 2 weeks, p = 0.035) than control patients at the end of the 60-days study period. There were no differences in unscheduled health-care utilization by group. Conclusions: These pilot data suggest that school-based administration of ICS has the potential to achieve high adherence to morning doses of ICS on school days among urban, disadvantaged, and largely minority children with asthma.     

Inhalation of Computer Duster Spray among Adolescents: An Emerging Public Health Threat?

Background: Anecdotal reports and recent medical examiner and poison control center studies suggest that computer duster spray (CDS) inhalation is an emerging public health threat. However, there is a current dearth of empirical data on CDS use. Objectives: Study aims were to examine the prevalence, frequency, correlates, and modalities of CDS use among a treatment sample of antisocial youth. Methods: A battery of standardized psychosocial instruments was administered via interview of 723 Missouri adolescents in residential care for antisocial behavior. Results: Lifetime CDS use was prevalent (14.7%) in this young service population (97.7% of whom participated). CDS users were significantly more likely to report histories of perinatal injuries or illness, traumatic experiences, suicidality and physician-diagnosed mental illness, and evidenced higher levels of psychiatric symptoms, antisocial attitudes and behaviors, and polydrug use than CDS nonusers. Conclusions and Scientific Significance: CDS use was endemic in this treatment sample of adolescents and associated with a range of clinically significant comorbidities. Current findings describe an underrecognized and potentially dangerous form of substance misuse that has rarely been studied but that may be of growing importance.     

Inhaled low-dose iloprost for pulmonary hypertension: a prospective, multicenter, open-label study

Background:

Inhaled iloprost (average >30 µg/d) has been considered an effective treatment for severe pulmonary hypertension (PH). Further evidence also showed that low‐dose iloprost given intravenously was equally effective as high‐dose iloprost in the therapy of systemic sclerosis.

Hypothesis:

Patients with pulmonary hypertension will benefit from inhalation of low‐dose iloprost.

Methods:

Sixty‐two patients with PH were enrolled and initiated with neubulizedlow‐dose iloprost (2.5 µg per inhalation, 6× daily) for 24 weeks in 13 medical centers in China. Efficacy endpoints included changes in 6‐minute walk distance (6MWD), World Health Organization functional class (WHO‐FC), and hemodynamic parameters.

Results:

Fourteen patients (22.6%) prematurely discontinued the study: 8 due to clinical worsening (6 in WHO‐FCIII–IV at baseline), 4 because of protocol change, and 2 patients lost during follow‐up. In the remaining 48 patients, 6MWD was increased from 356 ± 98 meters to 414 ± 99 meters (P < 0.001) and WHO‐FC improved significantly (P = 0.006) after 24‐week inhalation therapy. Cardiac output, cardiac index, and mixed venous oxygen saturation improved significantly compared with baseline (n = 34, P < 0.05). Most of the hemodynamic parameters improved significantly in patients in WHO‐FC II (P < 0.05) but not in patients in WHO‐FCIII–IV.

Conclusions:

Low‐dose iloprost inhalation significantly improved exercise capacity and functional status in patients with PH. It was well tolerated. The improvement of hemodynamics was confirmed in patients with WHO‐FCI–II but not in patients with WHO‐FCIII–IV, suggesting the importance of early treatment in patients with advanced disease stages. Clin. Cardiol. 2012 DOI: 10.1002/clc.21987 This study was supported by National Grant from the Ministry of Science and Technology (Beijing, China, project number 2006BAI01A07) and the Capital Development Scientific Fund (Beijing, China, project number 2005‐1018). The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

Reported exposure trends among healthcare personnel COVID-19 cases,USA, March 2020–March 2021

BackgroundHealth care personnel (HCP) have experienced significant SARS-CoV-2 risk, but exposure settings among HCP COVID-19 cases are poorly characterized.MethodsWe assessed exposure settings among HCP COVID-19 cases in the United States from March 2020 to March 2021 with reported exposures (n = 83,775) using national COVID-19 surveillance data. Exposure setting and reported community incidence temporal trends were described using breakpoint estimation. Among cases identified before initiation of COVID-19 vaccination programs (n = 65,650), we used separate multivariable regression models to estimate adjusted prevalence ratios (aPR) for associations of community incidence with health care and household and/or community exposures.ResultsHealth care exposures were the most reported (52.0%), followed by household (30.8%) and community exposures (25.6%). Health care exposures and community COVID-19 incidence showed similar temporal trends. In adjusted analyses, HCP cases were more likely to report health care exposures (aPR = 1.31; 95% CI:1.26-1.36) and less likely to report household and/or community exposures (aPR = 0.73; 95% CI:0.70-0.76) under the highest vs lowest community incidence levels.DiscussionThese findings highlight HCP exposure setting temporal trends and workplace exposure hazards under high community incidence. Findings also underscore the need for robust collection of work-related data in infectious disease surveillance.ConclusionsMany reported HCP cases experienced occupational COVID-19 exposures, particularly during periods of higher community COVID-19 incidence.