Analytical Enhancements in Kentucky’s Drug Overdose Mortality Surveillance: Rapid Monitoring of Trends and Decedents’ Recent Controlled Substance Prescription History

Background: Timely drug overdose mortality surveillance is key to informing public health action to reduce overdose-related fatalities. States are increasingly using linked data sources to enhance surveillance activities, yet approaches to their effective utilization and analyses are needed. Objectives: The objective of this study is to describe the development and utilization of analytical tools for rapid, ongoing monitoring of drug overdose trends in Kentucky (KY) and decedents’ exposure to prescribed controlled substances (CS). Methods: KY established a monthly process of linking all-cause death certificate (DC) with prescription drug monitoring program (DC-PDMP) data to enhance mortality surveillance. Using provisional 2018-2020 DC-PDMP data we developed scheduled quarterly analytical reports. Drug overdose deaths are identified based on underlying cause of death (ICD-10 X40-X44, X60-X64, X85, or Y10-Y14); involved drugs/drug classes are identified from multiple cause of death codes (T36 – T50). Common contributing substances are identified from DC cause of death section text fields. Drugs listed on DCs are compared with decedents’ past 90 days CS prescriptions. Results: KY resident drug overdose deaths accounted for 2.8% of all-cause mortality, but among age group 26-40 years, 28.6% of all-cause deaths were due to drug overdose. Drug overdose decedents were disproportionally male (65.4% vs. 51.8% among all-cause deaths). From 2018 to 2020, the number of drug overdose deaths increased 42%. Deaths involving synthetic opioids and psychostimulants increased (56.2%vs 71.7% and 27.3% vs 35.1%, respectively) and deaths involving heroin (10.4% vs 6.0%), benzodiazepines (24.1% vs 15.3%), cocaine (9.6% vs 8.4%) and natural/semi-synthetic opioids (22.7% vs 21.3%) declined. The five substances most frequently listed in the DC in 2020 were fentanyl, methamphetamine, 4-ANPP, gabapentin, and acetyl fentanyl. Sixty-three percent of deaths involving natural/semi- synthetic opioids and 76% of cases involving benzodiazepines had no dispensed prescriptions for those drug classes in the previous 90 days, suggesting possible diversion. A historically high level of drug overdose deaths was observed in the first months of COVID-19 pandemic, with April-June 2020 overdose deaths (n=557), 80%higher than the same period in 2019. Conclusions: The analytical enhancement of KY’s drug overdose surveillance supports rapid assessment to inform public health action and provides a rich dataset for pharmacoepidemiologic studies

Genome-wide diversity and gene expression profiling of Babesia microti isolates identify polymorphic genes that mediate host-pathogen interactions

Babesia microti, a tick-transmitted, intraerythrocytic protozoan parasite circulating mainly among small mammals, is the primary cause of human babesiosis. While most cases are transmitted by Ixodes ticks, the disease may also be transmitted through blood transfusion and perinatally. A comprehensive analysis of genome composition, genetic diversity, and gene expression profiling of seven B. microti isolates revealed that genetic variation in isolates from the Northeast United States is almost exclusively associated with genes encoding the surface proteome and secretome of the parasite. Furthermore, we found that polymorphism is restricted to a small number of genes, which are highly expressed during infection. In order to identify pathogen-encoded factors involved in host-parasite interactions, we screened a proteome array comprised of 174 B. microti proteins, including several predicted members of the parasite secretome. Using this immuno-proteomic approach we identified several novel antigens that trigger strong host immune responses during the onset of infection. The genomic and immunological data presented herein provide the first insights into the determinants of B. microti interaction with its mammalian hosts and their relevance for understanding the selective pressures acting on parasite evolution