Background Respiratory tract infections are common, often seasonal, and caused by multiple pathogens. We assessed whether seasonal respiratory illness patterns changed during the COVID-19 pandemic. Methods We categorized emergency department (ED) visits reported to the National Syndromic Surveillance Program according to chief complaints and diagnosis codes, excluding visits with diagnosed SARS-CoV-2 infections. For each week during March 1, 2020 through December 26, 2020 (“pandemic period”), we compared the proportion of ED visits in each respiratory category with the proportion of visits in that category during the corresponding weeks of 2017–2019 (“pre-pandemic period”). We analyzed positivity of respiratory viral tests from two independent clinical laboratories. Results During March 2020, cough, shortness of breath, and influenza-like illness accounted for twice as many ED visits compared with the pre-pandemic period. During the last four months of 2020, all respiratory conditions, except shortness of breath, accounted for a smaller proportion of ED visits than during the pre-pandemic period. Percent positivity for influenza virus, respiratory syncytial virus, human parainfluenza virus, adenoviruses, and human metapneumovirus were lower in 2020 than 2019. Although test volume decreased, percent positivity was higher for rhinovirus/enterovirus during the final weeks of 2020 compared with 2019; with ED visits similar to the pre-pandemic period. Discussion Broad reductions in respiratory test positivity and respiratory emergency department visits (excluding COVID-19) occurred during 2020. Interventions for mitigating spread of SARS-CoV-2 likely also reduced transmission of other pathogens. Timely surveillance is needed to understand community health threats, particularly when current trends deviate from seasonal norms.

A cross-sectional survey was conducted of sexually transmitted diseases (STDs) and risky behaviors among 407 drug abusers in treatment facilities in 1998. Infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus type 2 (HSV-2), and syphilis were detected by testing serum antibody levels; chlamydia and gonorrhea were detected by testing nucleic acid levels in urine. Logistic regression analysis was performed to measure associations. Prevalences of antibodies were as follows: to HSV-2, 44.4%; to HCV, 35.1%; to HBV, 29.5%; to HIV, 2.7%. The prevalence of syphilis was 3.4%; of chlamydia, 3.7%; and of gonorrhea, 1.7%. Of the 407 subjects, approximately 62% had markers for 1 of the STDs. HIV infection was associated with African American race, use of smokable freebase (crack) cocaine, and STD history. HBV infection was associated with age >30 years, injecting drugs, needle sharing, a history of treatment for drug abuse, and African American race. HCV infection was associated with an age >30 years, injecting drugs, and needle sharing, and HSV-2 infection with an age >30 years, female sex, and African American race. Syphilis was associated with a history of STDs. High prevalences of STDs among drug abusers indicate the need for integration of STD screening and treatment into drug treatment programs.

We conducted an anonymous cross-sectional seroprevalence study of a population with a low frequency of injection drug use to determine whether persons with a history of cosmetic procedures, such as tattooing and body piercing, or intranasal drug use were at increased risk for hepatitis C virus (HCV) or hepatitis B virus (HBV) infection. Students 18 years and older from eight college campuses in Houston, Texas, were invited to participate in the study. Of the 7,960 who completed a self-administered questionnaire and provided a blood sample, 5,282 U.S.-or Canadian-born participants were analyzed. Their median age was 21, 62% were female, 42% were white, 26% black, 22% Hispanic, and 10% Asian or other. Two percent reported injection drug use, 13.7% intranasal drug use, 21.2% body piercings, and 25.2% tattoos. The overall prevalence of HCV infection was 0.9% and of HBV infection was 5.2%. Higher HCV prevalence was independently associated with increasing age (odds ratio [OR] per year ‫؍‬ 1.11; 95% confidence interval [CI] ‫؍‬ 1.08-1.14), history of injection drug use (OR ‫؍‬ 18.24; 95% CI ‫؍‬ 7.74-42.92), blood transfusion before 1991 (OR ‫؍‬ 3.21; 95% CI ‫؍‬ 1.02-10.12), and incarceration (OR ‫؍‬ 3.48; 95% CI ‫؍‬ 1.45-8.37). Among 5,066 students who denied injecting drugs, HCV prevalence was 0.8% in those who reported intranasal drug use and 0.6% each in those who reported tattoos and those who reported body piercing. Increased HBV prevalence was associated with high-risk sexual behaviors and black or Asian race. In conclusion, there was no increased risk for HCV or HBV infection in low-risk adults based solely on history of cosmetic procedures or snorting drugs. However, proper infection control practices for cosmetic procedures should be followed, illegal drug use discouraged, and hepatitis B vaccination provided to adolescents and sexually active adults. (HEPATOLOGY 2006;44:341-351.)

We investigated sexually transmissable infection (STI) prevalence in 407 drug users in three drug treatment programmes in two Texan cities and associated demographic and sexual behaviours. Data analysis focused on differences between those for whom crack cocaine was the drug of preference compared with other drugs, since crack is associated with sexual arousal and a sex for drugs economy. Data indicate that having crack as a drug of preference is significantly associated with increased levels of previous STIs, previous drug treatment, African-American race, selling or buying sex for drugs or money, and increased infection markers for syphilis, chlamydia and herpes simplex-2. Crack preference was also significantly associated with lower rates of injecting drugs or sharing injection equipment and hepatitis C infection markers. Crack preference in heterosexual respondents was significantly associated with increased partner numbers in the past four weeks, more female partners for men and more vaginal sex contacts for men. Analysis of sex differences comparing those for whom crack was the preferred versus nonpreferred drug indicated that female crack users were significantly more likely to engage in oral sex. This supports previous ethnographic data suggesting that oral sex is a common mode of sex for drugs exchange in crack houses. In 7.4% of the total sample (14.4% of the crack-preferring sample), treatable STIs were detected. These data suggest that drug users generally, and crack-using populations in particular, in drug treatment programmes should be routinely screened for STIs as an integral part of drug treatment.