Publications by authors named "Thomas D Filardo"

A multistate measles outbreak, predominantly affecting members of close-knit communities with low measles vaccination coverage in New Mexico, Oklahoma, and Texas began in January 2025. As of April 17, a total of 800 cases have been reported in the United States in 2025; 654 (82%) cases in New Mexico, Oklahoma, and Texas have been associated with the ongoing outbreak. These cases represent an approximately 180% increase over the 285 measles cases reported in the United States during all of 2024, and the second highest annual case count in the United States in 25 years.

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On April 24, 2023, the American Samoa Department of Health (ASDoH) declared a public health emergency amid concern about a possible measles outbreak given low 2-dose vaccination coverage at the time. ASDoH had received two positive measles immunoglobulin (Ig) M test results after Flag Day festivities 1 week earlier from vaccinated children. ASDoH performed active case finding, took actions to mitigate transmission, and requested technical assistance from CDC.

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Article Synopsis
  • Research revealed a total of 1766 ocular tuberculosis (OTB) cases in the US from 1993 to 2019, making up 1.6% of all extrapulmonary tuberculosis (EPTB) cases, with a significant increase observed during the last decade.
  • Patients with OTB were generally older, more likely to be US-born, and had higher rates of diabetes compared to those with other EPTB forms, while being less frequently HIV positive.
  • OTB cases were often not lab confirmed, primarily relied on interferon gamma release assay tests for diagnosis, and highlighted the need for further research to improve understanding and treatment of OTB.
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Background: Despite high vaccine effectiveness, wild-type measles can occur in previously vaccinated persons. We compared the clinical presentation and disease severity of measles by vaccination status and age in the postelimination era in the United States.

Methods: We included U.

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Introduction: Testing for immunity to measles, mumps, and rubella should include only immunoglobulin G (IgG); immunoglobulin M (IgM) testing is appropriate only if acute illness is suspected. The appropriateness of measles, mumps, and rubella IgM testing was evaluated in a national administrative dataset.

Methods: Laboratory testing for measles, mumps, and rubella during 2019-2022 was analyzed in 2024 using HealthVerity administrative claims and laboratory data.

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Measles and rubella are vaccine-preventable viral diseases and can be prevented by safe, highly effective vaccination with measles- and rubella-containing vaccines. Given the myriad causes of febrile exanthems, laboratory surveillance for both measles and rubella is important to document the incidence of these diseases and to track the progress and maintenance of elimination in near- and post-elimination settings. Diagnostic challenges can hinder effective surveillance and classification challenges can hinder efforts to demonstrate achievement or maintenance of elimination.

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Background: People experiencing homelessness (PEH) are underrepresented in public health and clinical research. Study methods that can improve participation by this group are needed.

Methods: In late 2022, the Centers for Disease Control and Prevention conducted an mpox serological survey using venipuncture among PEH in San Francisco, California.

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Measles, a highly contagious respiratory virus with the potential to cause severe complications, hospitalization, and death, was declared eliminated from the United States in 2000; however, with ongoing global transmission, infections in the United States still occur. On March 7, 2024, the Chicago Department of Public Health (CDPH) confirmed a case of measles in a male aged 1 year residing in a temporary shelter for migrants in Chicago. Given the congregate nature of the setting, high transmissibility of measles, and low measles vaccination coverage among shelter residents, measles virus had the potential to spread rapidly among approximately 2,100 presumed exposed shelter residents.

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Measles is a highly infectious febrile rash illness and was declared eliminated in the United States in 2000. However, measles importations continue to occur, and U.S.

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  • The study investigates how breaking down racial and ethnic data impacts the understanding of tuberculosis (TB) among American Indian and Alaska Native (AI/AN) populations in the U.S.
  • Analysis of data from 2001 to 2020 showed that TB incidence was significantly higher in non-Hispanic AI/AN alone individuals compared to the overall AI/AN group.
  • Differences in health risk factors were noted between non-Hispanic AI/AN and multiracial/Hispanic AI/AN individuals, indicating that not including the latter in studies could lead to misleading conclusions about health disparities.
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In the United States, there is currently no system to track donated human tissue products to individual recipients. This posed a challenge during an investigation of a nationwide tuberculosis outbreak that occurred when bone allograft contaminated with Mycobacterium tuberculosis (Lot A) was implanted into 113 patients in 18 US states, including 2 patients at 1 health care facility in Colorado. A third patient at the same facility developed spinal tuberculosis with an isolate genetically identical to the Lot A outbreak strain.

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  • Mpox has impacted various communities in the U.S., particularly people experiencing homelessness (PEH), making vaccination crucial for disrupting transmission and protecting at-risk groups.
  • A survey of 273 PEH in San Francisco showed that 59% of those previously offered the vaccine accepted it, while 52% of those who hadn't been offered it expressed willingness to get vaccinated.
  • Vaccine acceptance was notably higher among transgender females and MSM (men who have sex with men), and efforts to improve vaccine education and address perceptions of personal risk could enhance vaccination rates among PEH.
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A systematic approach to contact investigations has long been a cornerstone of interrupting the transmission of tuberculosis in community settings. This paper describes the implementation of a systematic 10-step contact investigation within an acute care setting during a multistate outbreak of healthcare-associated tuberculosis. A systematic approach to contact investigations might have applicability to the prevention of other communicable infections within healthcare settings.

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  • Monkeypox (mpox) is a disease from the Orthopoxvirus family, which saw a significant outbreak starting in May 2022, primarily spread through close contact, especially sexual contact.
  • People experiencing homelessness have been disproportionately affected, but their specific mpox prevalence and transmission routes remain largely unknown, and they were not specifically targeted for mpox vaccinations during the outbreak.
  • A CDC survey conducted in San Francisco from October 25 to November 3, 2022, found potential undetected mpox infections among homeless individuals, indicating the crucial need for accessible community outreach and vaccination efforts for this vulnerable population.
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A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified 73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste.

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We report 2 immunocompetent and otherwise healthy adults in the United States who had monkeypox and required hospitalization for viral myocarditis. Both patients were unvaccinated against orthopoxviruses. They had shortness of breath or chest pain and elevated cardiac biomarkers.

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Article Synopsis
  • Monkeypox virus is an orthopoxvirus related to smallpox and is mainly found in Central and West Africa; the last U.S. outbreak occurred in 2003 linked to prairie dogs and imported African rodents.
  • A significant multinational outbreak since May 2022, particularly affecting gay and bisexual men, has resulted in around 25,000 cases reported globally, prompting the U.S. to declare it a public health emergency on August 4, 2022.
  • Tecovirimat is available for treating monkeypox, and can be used in patients with HIV without known drug interactions; prevention strategies include the JYNNEOS vaccine, with updates on health guidelines as more data is gathered.
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Background: Mycobacterium tuberculosis transmission through solid organ transplantation has been well described, but transmission through transplanted tissues is rare. We investigated a tuberculosis outbreak in the USA linked to a bone graft product containing live cells derived from a single deceased donor.

Methods: In this outbreak report, we describe the management and severity of the outbreak and identify opportunities to improve tissue transplant safety in the USA.

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  • The study investigates the occurrence and outcomes of nosocomial bloodstream infections (NBSIs) in COVID-19 patients hospitalized in New York City during the pandemic, highlighting the lack of understanding in this area due to varied disease presentations.
  • Researchers identified severe illness at hospital admission as a key risk factor for NBSIs, and found that these infections significantly increased mortality rates among affected patients.
  • The findings suggest that early identification of risk factors and timely treatment may reduce the mortality associated with NBSIs in COVID-19 patients, emphasizing the need for monitoring pathogen types throughout the hospital stay.
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During 1993-2019, the incidence of tuberculosis (TB) in the United States decreased steadily; however, during the later years of that period the annual rate of decline slowed (1) until 2020 when a substantial decline (19.9%) was observed. This sharp decrease in TB incidence might have been related to multiple factors coinciding with the COVID-19 pandemic, including delayed or missed TB diagnoses or a true reduction in TB incidence related to pandemic mitigation efforts and changes in immigration and travel (2).

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Importance: There is clinical equipoise for COVID-19 convalescent plasma (CCP) use in patients hospitalized with COVID-19.

Objective: To determine the safety and efficacy of CCP compared with placebo in hospitalized patients with COVID-19 receiving noninvasive supplemental oxygen.

Design, Setting, And Participants: CONTAIN COVID-19, a randomized, double-blind, placebo-controlled trial of CCP in hospitalized adults with COVID-19, was conducted at 21 US hospitals from April 17, 2020, to March 15, 2021.

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  • Disseminated strongyloidiasis and hyperinfection syndrome pose serious health risks post-transplantation, but pre-transplant screening and treatment can lessen these risks.
  • A study at a transplant center used universal serology-based screening for Strongyloides on 200 cardiothoracic transplant candidates, revealing that 12.4% tested positive for the infection.
  • The findings indicate that universal screening could allow for an average of 17 more candidates to receive preventive treatment for every 200 patients screened, highlighting its importance even in non-endemic areas.
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Background: Despite evidence of socio-demographic disparities in outcomes of COVID-19, little is known about characteristics and clinical outcomes of patients admitted to public hospitals during the COVID-19 outbreak.

Objective: To assess demographics, comorbid conditions, and clinical factors associated with critical illness and mortality among patients diagnosed with COVID-19 at a public hospital in New York City (NYC) during the first month of the COVID-19 outbreak.

Design: Retrospective chart review of patients diagnosed with COVID-19 admitted to NYC Health + Hospitals / Bellevue Hospital from March 9th to April 8th, 2020.

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