Medical and Research Library News

Training opportunities
Websites and reports on trending topics
Journal articles of note

Training opportunities

The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.

January 13, 2026; 2:30–4 p.m. State Community Health Worker Policy 101.
In a rapidly changing health policy landscape, community health workers (CHWs) remain a key workforce that connects people from their communities to health and social resources. Along with contributing to improved health outcomes, research shows that CHW services are cost-effective. States have been advancing strategies to increase access to CHW services through state policies, programs, and coverage approaches. This webinar from The National Academy for State Health Policy will introduce the basics of the state CHW policy space, including understanding the role of CHWs from a CHW perspective, CHW engagement in policy and program design, Medicaid reimbursement strategies, certification and training, and common challenges that states experience during policy development and implementation.

January 21, 2026; 1–2 p.m. The Next Public Health: Rethinking Health Communication for a Changing World.
How do we talk about public health in a world of misinformation and rapid change? With misinformation, uncertainty, and discord shaping public discourse, effective communication has never been more critical. This Population Health Spotlight Speaker Series event presented by Drexel Dornsife School of Public Health will feature Jennifer Manganello, PhD, MPH, professor at the University at Albany School of Public Health.

January 21, 2026; 2–3:30 p.m. Health Statistics on the Web.
Join this webinar from the Network of the National Library of Medicine (NNLM) to learn the difference between data and statistics, key features and use of health statistics, steps to finding health statistics, and sources of health statistics at the local, state and national level in this 90-minute webinar.

January 30, 2026; 1–2:30 p.m. Expanding School Wellness Policies to Encompass the Whole School, Whole Community, Whole Child Model: Lessons from Connecticut.
This webinar, offered by the DSHS Grand Rounds program, will cover the CDC’s Whole School, Whole Community, Whole Child Model (WSCC) model that shows how public health and education sectors can better coordinate their work to support each child’s cognitive, physical, social, and emotional development. This presentation will describe the USDA regulations currently in place; share measurement tools that have been developed to assess wellness policies and practices; and review how the state government is compiling actionable data to support school wellness in Connecticut.

Websites and reports on trending topics

The Cochrane Library is a resource that offers a collection of evidence-based medicine databases, including the Cochrane Database of Systematic Reviews. It provides up-to-date information on the effects of interventions in health care and evidence to support decisions taken in health care and to inform those receiving care. Search for systematic reviews, protocols, trials, methods studies, and more.

eBooks at EBSCOhost is a TexShare resource that offers the full-text of thousands of books on a variety of topics. It also hosts the eBook titles that the DSHS Library has purchased. When logged in through DSHS, you will find the library’s eBooks on public health and management topics in addition to the titles TexShare provides.

Table of Contents (TOCs) Request Form is a service provided by the DSHS Medical and Research Library to Texas HHS employees to receive newly published journal table of contents. Register to receive groups of journals or individual journal titles. Additional journals may be requested using the text box at the bottom of the form. TOCs are sent via email when published. Please contact the DSHS Medical and Research Library with any questions.

TDNet eResources is a gateway to access to library eJournals, eBooks, and databases. Click on the Journals or Books tabs to search for individual titles or use the Databases links to access different databases. For example, here are the top 10 most accessed DSHS Library journal titles in TDNet for 2025:
1. Lancet
2. JAMA
3. American Journal of Public Health
4. The New England Journal of Medicine
5. International Journal of Tuberculosis and Lung Disease
6. Pediatrics
7. Journal of Public Health Management and Practice
8. Journal of Hepatology
9. Vaccine
10. Obstetrics and Gynecology

Journal articles of note

Hsu CJ, Schraw JM, Rasmussen SA, et al. Structural birth defects and leukemia risk in children with Down syndrome. Sci Rep. Published online December 11, 2025. doi:10.1038/s41598-025-31340-3
Abstract
Birth defects are associated with increased cancer risk in the general pediatric population, yet their impact on leukemia risk in children with Down syndrome (DS) remains uncertain. We assessed this using data from 26,660 children with DS in the Genetic Overlap Between Anomalies and Cancer in Kids Registry Linkage Study. Among them, 71.9% had at least one major birth defect, predominantly involving the cardiac (64.2%), musculoskeletal (21%), and gastrointestinal systems (6.8%). The cumulative incidence of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) was comparable in children with and without co-occurring defects. Adjusted hazard ratios (aHR) for ALL and AML in children with versus without co-occurring major birth defects were 1.12 (95% confidence interval [CI]: 0.80-1.56) and 1.09 (95% CI: 0.76-1.58), respectively. Overall, no consistent patterns were seen between organ system-level defects and ALL. However, in terms of specific defects, we identified that anophthalmia/microphthalmia (aHR: 2.83, 95% CI: 1.16-6.92) was associated with ALL and tetralogy of Fallot (aHR: 2.40, 95% CI: 1.27-4.55) was associated with AML. While children with DS experience a higher prevalence of birth defects, these defects do not appear to strongly influence leukemia risk, unlike the elevated risk observed in the general pediatric population (< 18 years).

Koops A, Howell R, Allred RP, Jeon HN, Shumate C. Staff experiences with electronic initial case reports for birth defects surveillance in Texas. Birth Defects Res. 2025;117(12):e70002. doi:10.1002/bdr2.70002
Abstract
Background: Electronic case reporting (eCR) is increasingly used by public health agencies to support disease surveillance. Its utility for birth defects surveillance remains unexplored. This project aimed to evaluate birth defects surveillance staff experiences and perceptions of eCR data to identify its challenges, benefits, and opportunities for improvement in birth defects surveillance.
Methods: Two virtual, 1-h focus groups were conducted with 15 staff from the Texas Birth Defects Registry (TBDR) who had participated in a pilot evaluation of electronic initial case reports (eICRs). The focus groups explored staff experiences with identifying and abstracting cases from eICRs and how these experiences compared to abstraction from electronic health records (EHRs). Discussions followed a structured interview guide with six broad question categories. Detailed notes were taken during the sessions and analyzed using thematic analysis to identify common themes and patterns.
Results: Thematic analysis identified six key themes related to the eICR: Structure; Quality and Completeness; Comparison with EHRs; Technical and Workflow Challenges; Usefulness and Potential Applications; and Recommendations to Strengthen its Utility for Birth Defect Surveillance.
Conclusions: Staff reported that while eCR offers potential advantages, such as serving as a data source for case-finding, significant challenges remain. These include issues with eICR structure, data completeness, and integration into existing workflows. Recommended improvements include better organization of eICR data, inclusion of additional clinical details, and development of standardized abstraction protocols. These findings can inform strategies to optimize eCR for birth defects surveillance and point to the need for national guidelines.

Langan LM, Bain FL, Snow CC, et al. Spatially informed wastewater differentiation among locations during an ongoing measles outbreak in Texas, USA. ACS Environ Au. 2025;5(6):543-549. Published 2025 Sep 16. doi:10.1021/acsenvironau.5c00122
Abstract
Though reverse transcription-quantitative polymerase chain reaction (RT-qPCR), RT digital PCR (RT-dPCR), and RT digital droplet PCR (RT-ddPCR) are commonly used for wastewater-based epidemiology and surveillance (WBE/WBS), differences among the platforms exist. While RT-ddPCR has been suggested as an ideal approach to use globally for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monitoring, access to RT-qPCR instrumentation is more widely available in many regions, and it is more economical. Subsequently, a larger number of studies have used RT-qPCR for SARS-CoV-2 wastewater monitoring, along with additional pathogens that can be detected with WBS. In this study, we employed RT-qPCR and RT-dPCR platforms for the comparative detection of vaccine (A genotype Edmonston) and wild-type (D8 genotype) measles RNA from wastewater in nearby cities separated by <50 km during an ongoing measles outbreak in Texas, USA, in addition to several other locations up to 30-1400 km from the outbreak location. The limit of detection (LOD) for each methodology was evaluated using a synthetic gBlock DNA gene fragment of known concentrations, with comparable LODs identified for both the RT-dPCR (∼0.5 gc/μL) and RT-qPCR (∼0.4 gc/μL) platforms. Using composite supernatant-solid wastewater samples, RNA aliquots were analyzed on each platform in parallel. The RT-qPCR platform demonstrated a higher detection rate than RT-dPCR for the vaccine strain quantified in wastewater samples, with equivalent detections for the wild-type strain in both platforms, and notable differences in the gene copies quantified in wastewater based on the platform. Our study identifies that regardless of PCR methodology employed, WBS is a particularly valuable approach for the spatially informed differentiation of measles during rapid response to an active outbreak.

Shafer S, Stuteville H, Varney SM. Clinical outcomes of pediatric metformin exposures reported to the National Poison Data System®. Clin Toxicol (Phila). Published online November 26, 2025. doi:10.1080/15563650.2025.2587773
Abstract
Introduction: Prior studies suggest metformin exposures in young pediatric patients are low risk, and a triage threshold of 85 mg/kg can be used to reduce unnecessary evaluations. Our objective was to analyze single-substance metformin exposures using the National Poison Data System® to describe the clinical course, outcome, and mg/kg dose of metformin exposures in children under six years old. The secondary objective was to describe outcomes in patients divided into safe (≤85 mg/kg reported dose) and caution (>85 mg/kg reported dose) categories.
Methods: Using the National Poison Data System®, we analyzed single-substance metformin exposures from 2011-2021 in patients under six years old. We defined two categories of metformin overdose patients: safe (≤85 mg/kg reported dose), who could be managed at home, and caution (>85 mg/kg reported dose), who should be sent to a healthcare facility. Data were summarized with medians with interquartile ranges for continuous variables and percentages for categorical variables.
Results: There were 8,762 single-substance metformin exposures reported from 2011-2021. Most patients (6,493, 74.1%) were managed in a non-healthcare setting. Critical care admissions accounted for 73 (3.4%) exposures. For the 1,270 (14.5%) patients who had mg/kg data available, 1,081 (85.1%) were in the safe category with ingestions ≤85 mg/kg, while 189 (14.9%) were in the caution category with ingestions >85 mg/kg.
Discussion: Data were limited due to 59.4% of cases missing follow-up information. However, in patients with follow-up information available, most cases were managed on site (74.1%) and only 2.5% of cases required hospitalization. Caution range patients had ten times more admissions (6%) than safe range patients (0.6%).
Conclusion: Most exploratory pediatric single-agent metformin exposures were safe and could be managed at home. The ≤85 mg/kg threshold identifies exposures with expected good outcome requiring little to no medical management.

For more information, employees may email the Medical and Research Library at library@dshs.texas.gov to receive research assistance, learn how to access electronic materials, or to obtain the full text of articles mentioned in this month’s news.

The Medical and Research Library News is sent out once a month or when important library news or events occur. Recent issues of the MRL News are online. If any of the links do not open for you, please email library@dshs.texas.gov and we will send you what you need. Thank you!

If you would like to subscribe, please send an email to library@dshs.texas.gov with Subscribe in the subject line.

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Medical and Research Library News

Training opportunities
Websites and reports on trending topics
Journal articles of note

Training opportunities

The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.

December 2, 2025; 1–2 p.m. Bridging Trust and Care: The Unique Role of Community Health Workers in Dementia Efforts.
Join the Association of State and Territorial Health Officials (ASTHO) and the Building Our Largest Dementia (BOLD) Public Health Center of Excellence (PHCOE) for a webinar discussing how community health workers (CHWs) can address brain health and dementias in their communities. During this session, the BOLD PHCOE will showcase a new report, Community health workers: developing roles in public health dementia efforts in the United States. ASTHO will also highlight a new 
e-learning module, Equipping Community Health Workers to Address Alzheimer’s Disease and Related Dementias in Their Communities.

December 8, 2025; 1:30–2:30 p.m. Communicating about Public Health with Policymakers: Barriers, Strategies, and Tested Messages.
In December 2025, the de Beaumont Foundation will release Communicating About Public Health with Policymakers: A Toolkit for Public Health Professionals, a toolkit based on new research with former elected officials and senior aides, which provides tested messages, framing strategies, and practical tools to help public health professionals engage decision-makers with confidence and clarity. The research revealed three main barriers to effective communication with policymakers: public health is often seen as zero-sum, ideological rather than practical, and dismissive of individual agency. Join the de Beaumont Foundation, CityHealth, the National Association of Counties, and the American Public Health Association for a conversation on ways to overcome these barriers, strategic and on-the-ground tips for engaging policymakers, and ways to make every interaction with policymakers more productive, persuasive, and impactful.

December 9, 2025; 11 a.m.–12 p.m. Nicotine and Tobacco Use Among College Students in Texas.
Join this webinar from the Michael & Susan Dell Center for Healthy Living to learn about tobacco and nicotine use among young adults. Using data from large annually repeated cross-sectional samples of Texas college students, Dr. Caroline North will discuss the prevalence and trends in nicotine/tobacco use among Texas college students. Then, using data from the Vaping, Acculturation, and Media Study (Project VAMoS), a longitudinal cohort study of Mexican American college students in Texas, Dr. Bara S. Bataineh will discuss the role of social media in Mexican American young adults’ tobacco/nicotine use.

December 10, 2025; 1–2 p.m. Effective Health Communication and Health Literacy: Understanding the Connection.
How are health communication and health literacy connected? How can you be more effective in providing health information to consumers, patients, clients, and your community?  This one hour webinar from the Network of the National Library of Medicine (NNLM) introduces the concepts of health literacy and health communication, outlines components of clear health communication, and identifies online resources from NLM, government agencies and other recognized resources for health literacy and health communication.

Websites and reports on trending topics

speechBITE is a database of intervention studies across the scope of speech pathology practice. It includes evidence-based practices for speech pathologists, including systematic reviews, trials, clinical practice guidelines and more.

STAT!Ref is a DSHS Medical and Research Library resource that provides full text access to key medical reference sources. It includes Red Book, AMA coding manuals, medical dictionaries, drug guides, and many other medical reference books.

Trip is a clinical search engine of evidence-based content designed to support clinical practice and care. It includes research evidence and other content types including images, videos, patient information leaflets, educational courses, and news.

WastewaterSCAN Dashboard is based at Stanford University, in partnership with Emory University and Verily. It is a partnership that monitors diseases through municipal wastewater systems to inform local, regional, and national public health responses and reports findings to the US Centers for Disease Control and Prevention (CDC). WastewaterSCAN tests samples of solids from municipal wastewater for targets associated with infectious diseases.

Journal articles of note

Ayala JC, Hutton SM, Cartee JC, et al. A novel commensal Neisseria species harboring the gonococcal diagnostic marker DR-9 causes false-positive Roche cobas NAAT results. J Clin Microbiol. Published online November 19, 2025. doi:10.1128/jcm.01022-25
Abstract
Neisseria gonorrhoeae (Ng), the etiologic agent of gonorrhea, is the second most reported bacterial sexually transmitted infection globally. In the USA, nucleic acid amplification tests (NAATs) are considered the gold standard for diagnosis. Although NAATs are sensitive and offer high throughput, cross-reactivity with commensal Neisseria can compromise specificity. Here, we report the isolation and characterization of a novel commensal Neisseria sp. from the oropharynx of a patient with suspected gonococcal treatment failure. An initial diagnosis was made using the Roche cobas CT/NG test on the cobas 8800 system, which repeatedly yielded positive results post-treatment. A confirmatory Aptima Combo 2 (AC2, Hologic) test was negative, and multiple culture attempts failed to isolate Ng. Instead, a commensal Neisseria strain was recovered. Whole-genome sequencing revealed this isolate shared partial genomic identity with several Neisseria spp., including Ng, and carried a distinct region encoding the gonococcal diagnostic marker DR-9, the target of cobas assays. Cross-reactivity was confirmed with the cobas 4800 and 6800 platforms, but not with the AC2 assay targeting 16S rRNA. We discuss the possible origins of the DR-9 marker on this strain as well as examine its antimicrobial susceptibility profile and genomic resistance markers. These findings highlight the potential for misdiagnosis and unnecessary treatment when commensal Neisseria species harbor Ng diagnostic targets. Our study underscores the need for genomic surveillance of Ng and commensal Neisseria, not only to monitor diagnostic performance but also to track commensals that may serve as reservoirs of antimicrobial resistance determinants and contribute to the spread of resistance.
Importance
Accurate diagnosis of gonorrhea is critical for effective treatment and antimicrobial stewardship. Nucleic acid amplification tests, the mainstay of gonococcal diagnostic testing, can yield false-positive results due to genetic overlap between Neisseria gonorrhoeae and commensal Neisseria species, especially from extragenital sites like the oropharynx. Prior studies, such as Hopkins et al. (2023), have recognized this limitation and proposed supplemental tests to improve specificity for oropharyngeal specimens. Here, we describe a novel commensal Neisseria strain isolated from a patient with suspected treatment failure that harbors the gonococcal diagnostic marker DR-9. This case highlights the need for confirmatory testing using an alternate gene target in cases where repeated positive tests are obtained with extragenital specimens and demonstrates the need for improved test specificity, particularly for anatomical sites such as the pharynx, which has high commensal diversity. Enhanced molecular surveillance of commensal Neisseria populations will be vital for understanding and minimizing diagnostic cross-reactivity.

Brelsford B, Cravero JC, Telchik C, Phenis RA. Variations in West Nile viral infections across North and Central Texas. Proc (Bayl Univ Med Cent). 2025;38(6):843-850. Published 2025 Sep 4. doi:10.1080/08998280.2025.2555155
Abstract
Background: West Nile virus is a single-stranded RNA arbovirus with variable clinical presentation.
Methods: To better understand the clinical characteristics, diagnostic evaluation, and outcomes, we performed a retrospective analysis of the Baylor Scott & White Health medical records for hospitalized adult patients with West Nile virus from January 1, 2015, to September 1, 2024.
Results: A total of 79 patients were included. Most were male (55.7%) with a mean age of 64.15 years. The highest concentration of cases was reported in Dallas County (34.2%) and Tarrant County (22.8%). Seventy-three patients (92.4%) had neuroinvasive disease, while 6 patients (7.8%) had nonneuroinvasive disease. Presenting symptoms included fever (73.43%), confusion (49.59%), and weakness (40.51%). Six patients (7.6%) were found to have acute ischemic stroke during their admission. Fifteen patients (18.99%) died. Cerebrospinal fluid analysis generally showed elevated protein (mean value 104.7 mg/dL) with either neutrophilic (mean 32%) or lymphocytic pleocytosis (mean 51.6%). None of the treatments analyzed (intravenous immunoglobulin, plasma exchange, and steroids) was found to have any significant effect on morbidity and mortality.
Conclusion: West Nile virus is a common recurring disease across Texas. While some cases progress to neuroinvasive disease, there appears to be no meaningful way to predict these cases based on clinical and demographic data.

Goodwin Cartwright BM, Masters NB, Gilbert KM, Rodriguez PJ, Do D, Stucky N. Early MMR vaccine adoption during the 2025 Texas measles outbreak. JAMA Netw Open. 2025;8(11):e2543002. Published 2025 Nov 3. 
doi:10.1001/jamanetworkopen.2025.43002
Abstract
This cross-sectional study examines early vaccination rates for measles in Texas following updated 2025 guidance from the US Centers for Disease Control and Prevention. As of August 5, 2025, the US has reported 1356 measles cases, the largest number of cases since elimination was declared in 2000. Most of these cases have occurred in Texas. In response to the growing Texas outbreak, the US Centers for Disease Control and Prevention (CDC) issued updated guidelines through the Health Alert Network (HAN) on March 7, 2025, recommending early vaccination (ages 6 to 11 months) for children living in or traveling to affected counties. This study examined whether children in Texas received early measles vaccination following the HAN and assessed shifts in age-related vaccination patterns.

For more information, employees may email the Medical and Research Library at library@dshs.texas.gov to receive research assistance, learn how to access electronic materials, or to obtain the full text of articles mentioned in this month’s news.

The Medical and Research Library News is sent out once a month or when important library news or events occur. Recent issues of the MRL News are online. If any of the links do not open for you, please email library@dshs.texas.gov and we will send you what you need. Thank you!

If you would like to subscribe, please send an email to library@dshs.texas.gov with Subscribe in the subject line.

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Medical and Research Library News

Training opportunities
Websites and reports on trending topics
Journal articles of note

Training opportunities

The webinars and online classes listed here are shared solely as opportunities to learn more information of interest to public health personnel. All times listed are in Central Time.

November 4, 2025; 12–1 p.m. Nourishing Beginnings: Fueling Healthy Futures in the First 1,000 Days of Life.
This webinar from the Michael & Susan Dell Center for Healthy Living will explore the critical role of optimal nutrition during the first 1,000 days of life, from conception through toddlerhood, in shaping lifelong health, growth, and development.

November 12, 2025; 1–2 p.m. Ask Me Anything: Academic Health Department Partnerships.
Join the Association of State and Territorial Health Officials (ASTHO) and the Public Health Foundation (PHF) for a webinar focused on academic health department (AHD) partnerships. In this webinar, participants will gain a foundational understanding of AHD partnerships, with an introduction to the new AHD Partnerships Toolkit designed to support the development and sustainability of these partnerships. Then, the floor will open for your questions. Whether you're just getting started or looking to strengthen an existing partnership, this is your chance to ask us anything about AHD partnerships.

November 12, 2025; 1–2:30 p.m. How PubMed Works: Medical Subject Headings (MeSH).
Medical Subject Headings (MeSH) is the National Library of Medicine’s controlled vocabulary thesaurus that gives uniformity and consistency to the indexing and cataloging of biomedical literature. Join this webinar from the Network of the National Library of Medicine (NNLM) to explore the MeSH database, describe a controlled vocabulary, explore the four types of MeSH terms, locate and explain entry terms, date introduced, previous indexing, and automatic explosion.

November 19, 2025; 11 a.m.–12:30 p.m. DSHS Grand Rounds - Diabetes' Toll on Mental Health.
This webinar is offered by the DSHS Office of Practice and Learning Grand Rounds program. DSHS Grand Rounds explores the science and practice of population health and awards continuing education credits/contact hours for various disciplines. Visit the Grand Rounds calendar to see information on upcoming sessions. Held monthly on the fourth Wednesday, sessions last 90 minutes with the final 20 minutes reserved for Q&A.

Websites and reports on trending topics

medRxiv is a free online archive and distribution server for complete but unpublished manuscripts (preprints) in the medical, clinical, and related health sciences.

Our World in Data has a mission to publish research and data to make progress against the world’s largest problems. It includes more than 12,800 interactive charts and interactive visualization tools to explore a wide range of related indicators.

PolicyMap is a mapping tool provided by the Public Health Digital Library (PHDL). It allows users to dig deeper into place-based data and gain insights to help find solutions to the most tractable issues. It combines extensive data indicators with a contemporary, state of the art mapping platform and expanded analytics. As a PHDL consortium member, the DSHS Medical and Research Library provides this tool and many other public health information resources. Access is available through the PHDL portal. First time users will need to register with their DSHS email.

ProQuest Ebook Central is a science and technology ebook collection. It offers more than 28,000 ebooks titles in a diverse range of topics such as chemistry, physics, math, geology, geography, IT, computer science, engineering, agriculture, environmental studies, natural history, medicine, and more. Register here to create an account for access.

Journal articles of note

DeVita TN, Morrison AM, Stanek D, et al. Public health response to the first locally acquired malaria outbreaks in the US in 20 Years. JAMA Netw Open. 2025;8(10):e2535719. Published 2025 Oct 1. doi:10.1001/jamanetworkopen.2025.35719
Abstract
Importance: In 2023, the US reported 10 locally acquired mosquito-transmitted malaria cases of 4 genetic lineages in 4 states, the first such outbreaks detected in 20 years and the largest in 35 years.
Objective: To present the investigations, interventions, and challenges in the public health response to the malaria outbreaks and provide recommendations for future outbreaks.
Design, setting, and participants: This qualitative study was an interdisciplinary public health response to the locally acquired malaria outbreaks in May to December 2023 and included case investigations, enhanced case finding, polymerase chain reaction analysis of captured Anopheles spp mosquitoes for Plasmodium spp parasites, and novel targeted amplicon sequencing of Plasmodium spp in patient blood samples. Public health interventions included incident command activation, clinician outreach, community awareness, and vector control. Patient data were acquired through public health surveillance as part of National Notifiable Disease Surveillance.
Exposure: Plasmodium vivax-infected and Plasmodium falciparum-infected Anopheles spp mosquitoes.
Main outcomes and measures: Confirmed malaria infection via blood film microscopy and polymerase chain reaction, presence of Plasmodium spp in Anopheles spp mosquitoes, and genetic markers associated with an endemic region of origin and parasite strain relatedness via targeted amplicon sequencing.
Results: The study included 10 patients (mean [SD] age of 39.5 [15.0] years; 7 male [70%]) from Florida, Texas, Maryland, and Arkansas with locally acquired mosquito-transmitted malaria and 783 Anopheles spp mosquitoes across 4 states. No patient had a recent history of international travel or blood-borne exposures. Outbreak cases had epidemiologic links within but not across state lines. P vivax was detected in 3 Anopheles crucians in Florida. Sequencing data showed that all Florida P vivax cases shared the same Plasmodium strain. The Texas and Arkansas P vivax cases were genetically distinct from each other and from Florida's cases. All 9 P vivax strains had genetic signatures that were consistent with Central and South American origin. Maryland's P falciparum parasites were consistent with African origin. The outbreaks were contained.
Conclusions and relevance: In this qualitative study of locally transmitted malaria, outbreaks remained contained to individual counties, with Florida's P vivax cases linked to a single strain distinct from those in other states. Sustained Plasmodium spp transmission is unlikely in the US, though increases in global travel and migration, population, temperatures, and persistence of Anopheles spp vectors may increase risk for locally acquired malaria. Clinicians should prescribe chemoprophylaxis for patients traveling to endemic regions, ensure timely diagnosis and treatment, and facilitate public health reporting. Researching US Anopheles spp ecology and control methods while accelerating efforts to reduce malaria globally could mitigate future risk.

Huang W, Harrell MB, Page RL, et al. Nicotine consumption and folate insufficiency in pregnancy: a population-based cross-sectional study.  J Matern Fetal Neonatal Med. 2025;38(1):2577231. doi:10.1080/14767058.2025.2577231
Abstract
Objective: Tobacco smoking and folate insufficiency are both risk factors associated with adverse pregnancy outcomes, but their association in pregnancy remains unclear. This study investigated the association between tobacco smoking and folate insufficiency in pregnant women in the U.S.
Methods: Data from nine consecutive cycles of the National Health and Nutrition Examination Survey (2003-2020) were analyzed. Smoking status was derived from serum cotinine levels, and folate insufficiency was determined based on World Health Organization guidelines. The Rao-Scott test of independence was used to assess the prevalence of smoking and folate insufficiency across sociodemographic subgroups, and survey-weighted logistic regression models were used to evaluate the association between smoking and folate insufficiency.
Results: Both smoking and red blood cell (RBC) folate insufficiency showed high prevalence among non-Hispanic Black subgroups with an education level of high school or less. Compared to pregnant nonsmokers, pregnant smokers faced increased odds of RBC folate insufficiency (OR: 1.87; 95% CI: 1.10, 3.19). Approximately 3.6% (95% CI: 1.4, 6.4%) of cases of RBC folate insufficiency among pregnant women in the U.S. were associated with active smoking.
Conclusions: Tobacco smoking increases the risk of insufficient folate stores among pregnant women. However, healthcare providers should assess the folate status of all pregnant women and consider proactive screening, such as RBC folate testing, complemented by integrated strategies addressing tobacco use and nutritional risk. Proactive screening for smokers should be revisited once the prevalence of insufficient folate stores has been reduced at the population level.

Nelson A, Downey M, Murry M, et al. Emerging tick-borne disease risk in an urban center of Harris County, Texas. Vector Borne Zoonotic Dis. Published online October 20, 2025. doi:10.1177/15303667251386209
Abstract
Background: Tick-borne diseases are an endemic and emerging public health concern in the United States. Ongoing tick range expansion, invasive species, and newly identified pathogens are rapidly altering disease epidemiology. Surveillance is critical to understanding vector ecology and disease risk. Harris County, Texas, with nearly five million residents and diverse ecological zones, offers a unique setting to study local tick dynamics. 
Methods: From January 2021 to December 2022, we conducted weekly tick surveillance across 63 sites in Harris County (City of Houston), Texas. Ticks were morphologically identified and tested for Rickettsia, Borrelia, Ehrlichia, and Anaplasma via real-time PCR. Samples positive by initial screening were confirmed to the species level using endpoint PCR and sequencing. 
Results: We collected 1,219 ticks-primarily Ixodes scapularis and Amblyomma maculatum-with distinct seasonal and spatial patterns. Of 1,195 tested ticks, 61% were positive for Rickettsia, with multiple species identified. Notably, Rickettsia parkeri was detected in 23.1% of Rickettsia-positive A. maculatum ticks. 
Conclusion: Our findings reveal significant tick-borne pathogen activity in Harris County, highlighting the need for continued surveillance and public health efforts in urban and peri-urban Texas.

For more information, employees may email the Medical and Research Library at library@dshs.texas.gov to receive research assistance, learn how to access electronic materials, or to obtain the full text of articles mentioned in this month’s news.

The Medical and Research Library News is sent out once a month or when important library news or events occur. Recent issues of the MRL News are online. If any of the links do not open for you, please email library@dshs.texas.gov and we will send you what you need. Thank you!

If you would like to subscribe, please send an email to library@dshs.texas.gov with Subscribe in the subject line.

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