Problem/Condition Autism spectrum disorder (ASD). Period Covered 2018. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network conducts active surveillance of ASD. This report focuses on the prevalence and characteristics of ASD among children aged 8 years in 2018 whose parents or guardians lived in 11 ADDM Network sites in the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. In 2018, children met the case definition if their records documented 1) an ASD diagnostic statement in an evaluation (diagnosis), 2) a special education classification of ASD (eligibility), or 3) an ASD International Classification of Diseases (ICD) code. Results For 2018, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 16.5 in Missouri to 38.9 in California. The overall ASD prevalence was 23.0 per 1,000 (one in 44) children aged 8 years, and ASD was 4.2 times as prevalent among boys as among girls. Overall ASD prevalence was similar across racial and ethnic groups, except American Indian/Alaska Native children had higher ASD prevalence than non-Hispanic White (White) children (29.0 versus 21.2 per 1,000 children aged 8 years). At multiple sites, Hispanic children had lower ASD prevalence than White children (Arizona, Arkansas, Georgia, and Utah), and non-Hispanic Black (Black) children (Georgia and Minnesota). The associations between ASD prevalence and neighborhood-level median household income varied by site. Among the 5,058 children who met the ASD case definition, 75.8% had a diagnostic statement of ASD in an evaluation, 18.8% had an ASD special education classification or eligibility and no ASD diagnostic statement, and 5.4% had an ASD ICD code only. ASD prevalence per 1,000 children aged 8 years that was based exclusively on documented ASD diagnostic statements was 17.4 overall (range: 11.2 in Maryland to 29.9 in California). The median age of earliest known ASD diagnosis ranged from 36 months in California to 63 months in Minnesota. Among the 3,007 children with ASD and data on cognitive ability, 35.2% were classified as having an intelligence quotient (IQ) score ≤70. The percentages of children with ASD with IQ scores ≤70 were 49.8%, 33.1%, and 29.7% among Black, Hispanic, and White children, respectively. Overall, children with ASD and IQ scores ≤70 had earlier median ages of ASD diagnosis than children with ASD and IQ scores >70 (44 versus 53 months). Interpretation In 2018, one in 44 children aged 8 years was estimated to have ASD, and prevalence and median age of identification varied widely across sites. Whereas overall ASD prevalence was similar by race a...

Background Emerging COVID-19 pandemic caused extensive lockdowns in a number of countries, but yet unknown number of cases positive to SARS-CoV-2 escapes surveillance systems. Methods Mothers participating in an Italian NINFEA birth cohort were invited to complete an online questionnaire on COVID-19-like symptoms in the household. We estimated the population prevalence of COVID-19-like symptoms in children and adults, assessed their geographical correlation with the cumulative number of COVID-19 cases by province, analysed their clustering within families, and estimated their sensitivity, positive (PPV) and negative predictive values (NPV) for COVID-19 diagnosis in individuals tested for SARS-CoV-2. Results Information was collected on 3184 households, 6133 adults, and 5751 children. There was a strong geographical correlation between the population cumulative incidence of COVID-19 and the prevalence of muscle pain, fatigue, low-grade fever, and breathing di culties in adults (Spearman's rho ≥0.70). Having at least one family member with a COVID-19 diagnosis, compared with none tested for SARS-CoV-2, was associated with an increased prevalence ratio of almost all COVID-19-like symptoms in adults, and only of low-grade fever (37-37.5 o C; prevalence ratio 5.27; 95% con dence intervals: 2.37 to 11.74) and anosmia/dysgeusia in children. Among adults with COVID-19, fatigue, muscle pain, and fever had a sensitivity ≥70%. In individuals tested for SARS-CoV-2, with a 16.6% prevalence of COVID-19, breathing di culties and nausea/vomiting had the highest PPVs, with point estimates close to 60%, and with NPVs close to 90%. Among tested Piedmont residents, with a COVID-19 prevalence of 18.5%, breathing di culties and anosmia/disguesia reached PPVs above 80%. Conclusion Geographical prevalence of COVID-19-like symptoms in adults may inform on local disease clusters, while certain symptoms in family members of con rmed COVID-19 cases could help identi cation of the intra-familial spread of the virus and its further propagation in the community. Lowgrade fever is frequent in children with at least one household member with COVID-19 and possibly indicates child infection. geographical correlation between the symptoms' prevalence and the cumulative number of new SARS-CoV-2 positive cases reported by the Surveillance System, (iii) analyse the clustering of symptoms within families with or without a member who tested negative for SARS-CoV-2 or was diagnosed with COVID-19 and, nally, (iv) estimate the sensitivity, positive and negative predictive values for COVID-19-like symptoms in tested individuals of the NINFEA population. Methods Study design and population The NINFEA study is an Italian internet-based mother-child cohort (www.progettoninfea.it) set up to investigate the in uence of early-life exposures on later childhood and adulthood health. Between 2005 and 2016, approximately 7,500 pregnant women were recruited by completing the baseline questionnaire, and the children are currently followed up with questionnaires complete...

Background: Coronavirus Disease-2019 (COVID-19) has become a major health event that endangers people health throughout China and the world. Understanding the factors associated with COVID-19 disease severity could support the early identi cation of patients with high risk for disease progression, inform prevention and control activities, and potentially reduce mortality. This study aims to describe the characteristics of patients with COVID-19 and factors associated with severe or critically ill presentation. Methods: Multicentre retrospective cohort study of all individuals with con rmed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infections diagnosed at 24 COVID-19-designated hospitals in Jiangsu province between the 10th January and 15th March 2020. Demographic, clinical, laboratory, and radiological data were collected at hospital admission and data on disease severity were collected at from admission. Patients were categorised as asymptomatic/mild/moderate, and severe/critically ill according to the worst level of COVID-19 recorded during hospitalisation. Results: A total of 625 patients, 64 (10.2%) were severe/critically ill and 561 (89.8%) were asymptomatic/mild/moderate. All patients were discharged and no patients died. Patients with severe/critically ill COVID-19 were more likely to be older, to be single onset (i.e. not to a cluster of cases in family/community), to have a medical history of hypertension and diabetes; had higher temperature, faster respiratory rates, lower peripheral capillary oxygen saturation (SpO 2), and higher CT image quadrant scores and pulmonary opacity percentage; had increased C-reactive protein, brinogen, and Ddimer on admission; and had lower white blood cells, lymphocyte, and platelet counts and albumin on admission than asymptomatic/mild/moderate cases. Multivariable regression showed that odds of being a severe/critically ill case were associated with age (year) (OR 1.06, 95%CI 1.03-1.09), lymphocyte count (10 9 /L) (OR 0.25, 95%CI 0.08-0.74), and pulmonary opacity in CT (per 5%) on admission (OR 1.31, 95%CI 1.15-1.51). Conclusions: Severe or critically ill patients with COVID-19 is about one-tenths of patients in Jiangsu. Age, lymphocyte count, and pulmonary opacity in CT on admission were associated with risk of severe or critically ill COVID-19. Background Coronavirus Disease (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), was rst reported from Wuhan, Hubei province, China, in December 2019 and spread quickly from a focal outbreak with 41 cases to over 7 410, 000 cases with more than 136, 000 deaths affecting more than 140 countries by June 2020. 1 The World Health Organization (WHO) declared a pandemic affecting all continents the 11 th March 2020. 2 China has reported over 84, 000 con rmed cases by the 16 th June. 1 Although the epicentre of the epidemic was located in Wuhan, other provinces became affected in the following weeks. In a case series

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Problem/Condition Autism spectrum disorder (ASD). Period Covered 2020. Description of System The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance program that provides estimates of the prevalence of ASD among children aged 8 years. In 2020, there were 11 ADDM Network sites across the United States (Arizona, Arkansas, California, Georgia, Maryland, Minnesota, Missouri, New Jersey, Tennessee, Utah, and Wisconsin). To ascertain ASD among children aged 8 years, ADDM Network staff review and abstract developmental evaluations and records from community medical and educational service providers. A child met the case definition if their record documented 1) an ASD diagnostic statement in an evaluation, 2) a classification of ASD in special education, or 3) an ASD International Classification of Diseases (ICD) code. Results For 2020, across all 11 ADDM sites, ASD prevalence per 1,000 children aged 8 years ranged from 23.1 in Maryland to 44.9 in California. The overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Overall, ASD prevalence was lower among non-Hispanic White children (24.3) and children of two or more races (22.9) than among non-Hispanic Black or African American (Black), Hispanic, and non-Hispanic Asian or Pacific Islander (A/PI) children (29.3, 31.6, and 33.4 respectively). ASD prevalence among non-Hispanic American Indian or Alaska Native (AI/AN) children (26.5) was similar to that of other racial and ethnic groups. ASD prevalence was associated with lower household income at three sites, with no association at the other sites. Across sites, the ASD prevalence per 1,000 children aged 8 years based exclusively on documented ASD diagnostic statements was 20.6 (range = 17.1 in Wisconsin to 35.4 in California). Of the 6,245 children who met the ASD case definition, 74.7% had a documented diagnostic statement of ASD, 65.2% had a documented ASD special education classification, 71.6% had a documented ASD ICD code, and 37.4% had all three types of ASD indicators. The median age of earliest known ASD diagnosis was 49 months and ranged from 36 months in California to 59 months in Minnesota. Among the 4,165 (66.7%) children with ASD with information on cognitive ability, 37.9% were classified as having an intellectual disability. Intellectual disability was present among 50.8% of Black, 41.5% of A/PI, 37.8% of two or more races, 34.9% of Hispanic, 34.8% of AI/AN, and 31.8% of White children with ASD. Overall, children with intellectual disability had earlier median ages of ASD diagnosis (43 months) than those without intellectual disability (53 months). Interpretation For 2020, one in 36 children aged 8 years (approximately 4% of boys and 1% of girls) was estimated to have ASD. These estimates a...