Impact of Statewide Prevention and Reduction of Clostridioides difficile (SPARC), a Maryland public health–academic collaborative: an evaluation of a quality improvement intervention

To evaluate changes in Clostridioides difficile incidence rates for Maryland hospitals that participated in the Statewide Prevention and Reduction of C. difficile (SPARC) collaborative. Pre-post, difference-in-difference analysis of non-randomised intervention using four quarters of preintervention and six quarters of postintervention National Healthcare Safety Network data for SPARC hospitals (April 2017 to March 2020) and 10 quarters for control hospitals (October 2017 to March 2020). Mixed-effects negative binomial models were used to assess changes over time. Process evaluation using hospital intervention implementation plans, assessments and interviews with staff at eight SPARC hospitals. Maryland, USA. All Maryland acute care hospitals; 12 intervention and 36 control hospitals. Participation in SPARC, a public health–academic collaborative made available to Maryland hospitals, with staggered enrolment between June 2018 and August 2019. Hospitals with higher C. difficile rates were recruited via email and phone. SPARC included assessments, feedback reports and ongoing technical assistance. Primary outcomes were C. difficile incidence rate measured as the quarterly number of C. difficile infections per 10 000 patient-days (outcome measure) and SPARC intervention hospitals’ experiences participating in the collaborative (process measures). SPARC invited 13 hospitals to participate in the intervention, with 92% (n=12) participating. The 36 hospitals that did not participate served as control hospitals. SPARC hospitals were associated with 45% greater C. difficile reduction as compared with control hospitals (incidence rate ratio=0.55, 95% CI 0.35 to 0.88, p=0.012). Key SPARC activities, including access to trusted external experts, technical assistance, multidisciplinary collaboration, an accountability structure, peer-to-peer learning opportunities and educational resources, were associated with hospitals reporting positive experiences with SPARC. SPARC intervention hospitals experienced 45% greater reduction in C. difficile rates than control hospitals. A public health–academic collaborative might help reduce C. difficile and other hospital-acquired infections in individual hospitals and at state or regional levels.

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Hand-foot-and-mouth disease and weather factors in Guangzhou, southern China

Epidemiology and Infection ◽

10.1017/s0950268813002938 ◽

2013 ◽

Vol 142 (8) ◽

pp. 1741-1750 ◽

Cited By ~ 27

Author(s):

T. LI ◽

Z. YANG ◽

B. DI ◽

M. WANG

Keyword(s):

Public Health ◽

Negative Binomial ◽

Southern China ◽

Foot And Mouth Disease ◽

Incidence Rates ◽

Mouth Disease ◽

Control Measures ◽

High Morbidity ◽

Weather Factors ◽

Foot And Mouth

SUMMARYHand-foot-and-mouth disease (HFMD) is becoming one of the common airborne and contact transmission diseases in Guangzhou, southern China, leading public health authorities to be concerned about its increased incidence. In this study, we aimed to examine the effect of weather patterns on the incidence of HFMD in the subtropical city of Guangzhou for the period 2009–2012, and assist public health prevention and control measures. A negative binomial multivariable regression was used to identify the relationship between meteorological variables and HFMD. During the study period, a total of 166 770 HFMD-confirmed cases were reported, of which 11 died, yielding a fatality rate of 0·66/10 000. Annual incidence rates from 2009 to 2012 were 132·44, 311·40, 402·76, and 468·59/1 000 00 respectively. Each 1°C rise in temperature corresponded to an increase of 9·38% (95% CI 8·17–10·51) in the weekly number of HFMD cases, while a 1 hPa rise in atmospheric pressure corresponded to a decrease in the number of cases by 6·80% (95% CI −6·99 to −6·65), having an opposite effect. Similarly, a 1% rise in relative humidity corresponded to an increase of 0·67% or 0·51%, a 1 m/h rise in wind velocity corresponded to an increase of 4·01% or 2·65%, and a 1 day addition in the number of windy days corresponded to an increase of 24·73% or 25·87%, in the weekly number of HFMD cases, depending on the variables considered in the model. Our findings revealed that the epidemic status of HFMD in Guangzhou is characterized by high morbidity but low fatality. Weather factors had a significant influence on occurrence and transmission of HFMD.

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Temporal Change of Risk Factors in Hospital-Acquired Clostridioides difficile Infection Using Time-Trend Analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1050 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s403-s403

Author(s):

Jiyoun Song ◽

Bevin Cohen ◽

Philip Zachariah ◽

Jianfang Liu ◽

Elaine Larson

Keyword(s):

Risk Factors ◽

New York ◽

High Risk ◽

Kendall Test ◽

Incidence Rates ◽

Clostridioides Difficile ◽

Significant Downward Trend ◽

Hospital Acquired ◽

The Impact ◽

Over Time

Background: In the past few decades, the epidemiology of Clostridioides difficile infection (CDI) has evolved. Given recent changes in the incidence of CDI and prevention efforts, we investigated temporal changes over a period of 8 years (2009–2016) in the incidence of and risk factors for CDI. Methods: Both pediatric and adult inpatients discharged from hospitals in metropolitan New York City were included. Individual and environmental (eg, pharmacological) risk factors were identified through a matched case-control by the length of stay at a ratio of 1:4. A Cochran–Armitage test or Mann-Kendall test was used to investigate trends of incidence and risk factors. Results: During the study period, 6,038 of 694,849 (0.87%) patients had a positive test for C. difficile during their hospitalization. Of these, 2,659 of 6,038 (44.04%) were identified as hospital-acquired CDI (HA-CDI) and just over half (3,379 of 6,038, 55.96%) were identified as community-acquired CDI (CA-CDI). There were no trends in total CDI incidence rates; rather, we detected downward trends in HA-CDI and upward trends in CA-CDI (Ptrend < .05). Younger patients and patients with lower risk of illness had HA-CDI over time (Ptrend < .05). Antibiotics were administered to more patients over time and in longer cumulative days (+3% and +3.1% per year). We detected a reduction in the receipt of high-risk antibiotics in all cohorts (−0.12% per year) and a decrease in cumulative days of high-risk antibiotics in the cohort with HA-CDI (−1.1% per year). When stratified by the type of high-risk antibiotics, the use of carbapenem, cephalosporins, clindamycin, and monobactam increased (+0.53%, +1.8%, +0.5%, and +0.39% per year, respectively), whereas the use of broad-spectrum penicillins and glycylcycline significantly decreased over time in all cohorts (−1.8% and −0.22% per year). Among the cohorts with HA-CDI, only cephalosporins showed a significant upward trend (+ 5.7% per year) and only fluoroquinolones showed a significant downward trend (−2.2% per year). Lastly, a reduction of proton pump inhibitors and an increased use of histamine-2 blockers were detected in all cohorts (−3.8% and +7.3% per year) (all Ptrend < .05). Conclusions: Although the incidence of HA-CDI decreased, more effort to decrease all antibiotics use and cumulative days should be emphasized as part of antibiotic stewardship. The downward trends of high-risk antibiotics might have been associated with the decrease in the trend of HA-CDI; however, the impact of the trends of risk factors on the trend of HA-CDI should be further investigated.Funding: NoneDisclosures: None

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Suicides in Belgrade, Serbia in the period 2009-2018

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1181 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Miltenovic ◽

M Vujetic

Keyword(s):

Public Health ◽

Incidence Rate ◽

Health Problem ◽

Causes Of Death ◽

Age Groups ◽

Public Health Problem ◽

Incidence Rates ◽

Major Public Health Problem ◽

Health It ◽

Icd 10

Abstract Background Suicides fall in violent deaths and more recently have shown an increasing trend in developed and developing countries. This is a major public health problem that could and should be prevented. Unfortunately, it is among the top twenty leading causes of death worldwide. This public health problem exists in Belgrade and Serbia, as well. Methods An analysis of death certificates shows an insight into the causes of death of inhabitants of Belgrade. The paper presents data from the Database of deceased persons in Belgrade, for the period 2009- 2018. Data are analyzed using frequencies and incidence rates by sex, age groups, month of death, day of death, and municipality of residence of deceased. Results In Belgrade, from 2009 to 2018 the incidence rate of suicides is decreasing. The standardized suicide rate was highest in 2009 (12/100.000). Men often committed suicides at all observed years, and the rates are usually higher as in women. The highest number of suicides occur in April, July and June and observing days within a week Wednesday and Tuesday lead. The average age of men who committed suicide was 57 years and women 59.5 years. The most common method of carrying out the suicide was 'by hanging, strangulation and suffocation' (X70 according to ICD-10) and frequency was 45.2%. Conclusions The incidence rate of suicides at Belgrade territory shows the trend of decline in the observed period, between 2009 and 2018. Besides that, other attributes indicate that age-sex-manner of suicides could be changed, as for being targeted for prevention. Preventing suicides is a new challenge for public health and all public sectors have to be involved in prevention. Considering ageing of a population, migration and other negative demographic trends in Belgrade and Serbia, it is necessary to raise our competencies in inhibition of these unfortunate events. Key messages Preventing suicides is a challenge for public health. It is necessary to raise competencies in order to prevent suicides.

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Spatial Distribution of Zika in Honduras during 2016–2017 Using Geographic Information Systems (GIS)—Implications in Public Health and Travel Medicine

10.20944/preprints201811.0621.v2 ◽

2019 ◽

Author(s):

Lysien I. Zambrano ◽

Walter O. Vasquez-Bonilla ◽

Itzel Carolina Fuentes-Barahona ◽

José Cláudio da Silva ◽

Jorge Alberto Valle-Reconco ◽

...

Keyword(s):

Public Health ◽

Information Systems ◽

Incidence Rate ◽

Geographical Information Systems ◽

Travel Medicine ◽

Epidemiological Data ◽

Incidence Rates ◽

Geographical Information ◽

Zikv Infection ◽

Disease Characteristics

Background: Zika virus (ZIKV) infection has significantly affected Latin America in 2015–2017. Most studies have been reported from Brazil and Colombia, and only a few from Central America. For these reasons we analyzed the incidence, incidence rates and evolution of cases in Honduras from 2016–2017. Methods: Using epidemiological weeks (EW) surveillance data on the ZIKV epidemics in Honduras, we estimated incidence rates (cases/100,000 population), and developed maps at national, departmental and municipal levels. Results: From 1 January 2016 to 31 December 2017, a total of 32,607 cases of ZIKV were reported (98.5% in 2016 for an incidence rate of 36.85 cases/100,000 pop; 1% confirmed by RT-PCR). The highest peak was reached on the EW 6°, 2016 (2,559 cases; 29.34 cases/100,000 pop). The department with the highest number of cases and incidence rate was Cortés (13,128 cases, 791.08 cases/100,000 pop in 2016). Discussion: The pattern and evolution of ZIKV infection in Honduras has been similar to that which occurred for chikungunya in 2015. As previously reported, infection with chikungunya involved predominantly the central and capital area of the country, reaching incidences there >750 cases/100,000 pop.  Studies using geographical information systems linked with clinical disease characteristics are necessary to attain accurate epidemiological data for public health systems. Such information is also useful for assessment of risk for travelers who visit specific areas in a destination country.

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Recent trends in the incidence of hip fracture in Tottori Prefecture, Japan: changes over 32 years

Archives of Osteoporosis ◽

10.1007/s11657-020-00823-3 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hiroshi Hagino ◽

Mari Osaki ◽

Reiko Okuda ◽

Shinpei Enokida ◽

Hideki Nagashima

Keyword(s):

Hip Fracture ◽

Incidence Rate ◽

Hip Fractures ◽

Trochanteric Fracture ◽

Incidence Rates ◽

Number Of Patients ◽

Neck Fracture ◽

Tottori Prefecture ◽

Changes Over Time ◽

Over Time

Abstract Summary The incidence rate of hip fracture in Tottori Prefecture tended to increase until 2018 in men, but it did not increase after 2010 in women. By type of fracture, the incidence rate of femoral neck fractures also increased over time in men, but no other changes were observed from 2010. Purpose The aims of this study were to determine the sex-, age-, and fracture-type-specific incidence rates of hip fractures in Tottori Prefecture between 2007 and 2018 and to compare the results with our past results to identify changes over time. Methods All hip fractures in people aged 35 years or older living in Tottori Prefecture were surveyed from 2007 to 2018 throughout the entire prefecture, and the age- and sex-specific incidence rates were calculated. The incidence rates from 1986 to 1988, 1992 to 1994, 1998 to 2000, and 2004 to 2006 previously reported were used for the analysis. Results In men, the age-adjusted number of patients adjusted by demographic structure based on the mean incidence rate for each 3-year period from 1986 to 2018 showed an increase in incidence over time compared with the incidence for 1986–1988 (p < 0.001). In women, the incidence rose over time compared with the incidence for 1986–1988 until 2004–2006 (p < 0.001), and no further increase was observed from 2010. The age-specific incidence rates of neck fracture in men were higher in 2010–2012 and 2016–2018 compared with 2004–2006 (p < 0.001), but those in women showed no increase with time. Those of trochanteric fracture did not change over time in either men or women. Conclusion The hip fracture incidence rate in Tottori Prefecture, Japan, tended to increase until 2018 in men, but it did not increase after 2010 in women.

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Disparities in Shigellosis Incidence by Census Tract Poverty, Crowding, and Race/Ethnicity in the United States, FoodNet, 2004–2014

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa030 ◽

2020 ◽

Vol 7 (2) ◽

Author(s):

Tanya Libby ◽

Paula Clogher ◽

Elisha Wilson ◽

Nadine Oosmanally ◽

Michelle Boyle ◽

...

Keyword(s):

United States ◽

Incidence Rate ◽

Census Tract ◽

Negative Binomial ◽

Geographic Location ◽

Negative Binomial Regression ◽

The United States ◽

Incidence Rates ◽

Surveillance Network ◽

Race Ethnicity

Abstract Background Shigella causes an estimated 500 000 enteric illnesses in the United States annually, but the association with socioeconomic factors is unclear. Methods We examined possible epidemiologic associations between shigellosis and poverty using 2004–2014 Foodborne Diseases Active Surveillance Network (FoodNet) data. Shigella cases (n = 21 246) were geocoded, linked to Census tract data from the American Community Survey, and categorized into 4 poverty and 4 crowding strata. For each stratum, we calculated incidence by sex, age, race/ethnicity, and FoodNet site. Using negative binomial regression, we estimated incidence rate ratios (IRRs) comparing the highest to lowest stratum. Results Annual FoodNet Shigella incidence per 100 000 population was higher among children <5 years old (19.0), blacks (7.2), and Hispanics (5.6) and was associated with Census tract poverty (incidence rate ratio [IRR], 3.6; 95% confidence interval [CI], 3.5–3.8) and household crowding (IRR, 1.8; 95% CI, 1.7–1.9). The association with poverty was strongest among children and persisted regardless of sex, race/ethnicity, or geographic location. After controlling for demographic variables, the association between shigellosis and poverty remained significant (IRR, 2.3; 95% CI, 2.0–2.6). Conclusions In the United States, Shigella infections are epidemiologically associated with poverty, and increased incidence rates are observed among young children, blacks, and Hispanics.

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Neighborhood disparities in stroke and socioeconomic, urban-rural factors using stroke registry

European Journal of Public Health ◽

10.1093/eurpub/ckz187.132 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

C Padilla ◽

O Grimaud ◽

E Nowak ◽

S Timsit

Keyword(s):

Public Health ◽

Negative Binomial ◽

Disease Risk ◽

Incidence Rates ◽

Regression Coefficients ◽

Rural Setting ◽

Health Prevention ◽

Local Regression ◽

Stroke Incidence ◽

Urban Rural

Abstract Introduction Despite major improvements in management over recent decades, stroke remains a devastating disease in Europe and geographic disparities persist. Determining the spatial distribution of stroke may be useful for both epidemiological research and health services planning. The aim of this study was to estimate stroke incidence rates in Pays de Brest (Western France) and to explore the presence of geographic clusters associated with socioeconomic and urban-rural characteristics. Methods The study included incidence stroke cases aged 60 years and more from the Stroke Brest registry for the period 2008 to 2013 aggregated at the census block level. Poisson and negative binomial regression models were used to explore determinants of disease risk. Geographically weighted regression (GWR) was used to allow estimation of local regression coefficients. Results Between 2008 and 2013, 3088 cases aged 60 years were identified in Pays de Brest. The incidence of stroke was 6.67 per 1 000 inhabitants. Living in a rural neighborhood with a higher level of blue collar and of farmer was associated with higher age adjusted stroke incidence rate ratio (IRR) 1.23, [95%CI 1.09-1.39]. Higher risk was also found in a city center neighborhood with a higher level of blue [IRR 1.22, 95%CI 1.04-1.49]. Local Poisson GWR models achieved the best fit and suggested evidence of spatially varying regression coefficients and clusters of higher incidence. Conclusions Our study contributes to a better understanding of the relationship between stroke risks and contextual characteristics such as socioeconomic circumstances and urban rural setting. This will help targeting areas for specific public health prevention. Key messages Variations of stroke were marked according to socioeconomic and urban-rural setting of the living area. This study will help targeting areas for specific public health prevention.

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Evaluating Facility Characteristics and Connectivity Metrics as Predictors of Clostridioides difficile Rates in Nursing Homes, Atlanta, GA

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.515 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s35-s36

Author(s):

Samantha Sefton ◽

Dana Goodenough ◽

Sahebi Saiyed ◽

Scott Fridkin

Keyword(s):

Negative Binomial ◽

Average Length ◽

Incidence Rates ◽

Inverse Association ◽

Emerging Infections ◽

Residual Variability ◽

Healthcare Network ◽

Clostridioides Difficile ◽

Specimen Collection ◽

Incident Cases

Background: Nursing home (NH) residents are at high risk for Clostridioides difficile infection (CDI) due to older age, frequent antibiotic exposure, and previous healthcare exposure. Incidence of CDI attributed to NHs is not well established, but it is hypothesized to be related to the magnitude of transfers. We evaluated the relationship between NH CDI incidence and facility characteristics to explain variability in rates in Atlanta, Georgia. Methods: Incident C. difficile cases from 2016 to 2018 were identified through the Georgia Emerging Infections Program (funded by the Centers for Disease Control and Prevention), which conducts active population-based surveillance in the 8-county metro Atlanta area. An incident case was defined as an NH resident with a toxin-positive stool specimen (without a positive test within 8 weeks). Sampled (1 to 3 on age and gender) incident cases were attributed to a NH if a patient was an NH resident within 4 days of specimen collection. Facility characteristics (beds, resident days, admissions, and average length of stay [ALOS]) were obtained from NH cost reports, and facility-specific connectivity metrics were calculated (indegree and betweenness) from 2016 Medicare claims data. Case counts were aggregated to estimate yearly incidence and correlated with facility characteristics and location within the healthcare network using the Spearman correlation. A negative binomial model was used to assess residual variability in NH CDI incidence. Results: In total, 386 incident CDI cases were attributed to 64 NHs (range, 0–27). Approximately half (54.7%) resided in the NH at the time of specimen collection; however, 33.7% were in inpatient units (≤4 days of admission), and 10.9% were in an emergency room (ER). The frequency of NH CDI cases correlated strongly with admissions (r = .70; P < .01), inversely with ALOS (r = −0.53; P < .01), and moderately with resident days (r = .38; P < .01). After accounting for admissions, incidence (per 1,000 admissions) still varied (Fig. 1) (median 14; range, 0–34). The inverse association with ALOS decreased and incidence no longer correlated with the remaining facility characteristics or location within the healthcare transfer network (P > .05, all comparisons). However, there was residual correlation with connectivity metrics (indegree r = 0.26; P = .04). Conclusions: Our data suggest that attributing CDI to NHs requires the inclusion of hospital and ER-based specimen collection. NH CDI incidence appears highest among facilities with a low ALOS and a high number of admissions; incidence rates calculated per 1,000 admissions may best account for infection risk inherent early in a resident’s stay. Residual variability attributed to connectivity to the healthcare network was of borderline significance and should be further explored in the NH setting.Funding: NoneDisclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)

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Infection Control, Antimicrobial Consumption, and Hospital-Acquired Clostridioides difficile Infection in Acute-Care Hospitals in Catalonia

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1160 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s483-s484

Author(s):

Esther Calbo ◽

Laia Castellà ◽

Ana Hornero ◽

Nieves Larrosa ◽

Nieves Sopena ◽

...

Keyword(s):

Infection Control ◽

Regression Model ◽

Incidence Rate ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Geographical Area ◽

Antimicrobial Consumption ◽

Control Policies ◽

Clostridioides Difficile ◽

Hospital Acquired

Background: Hospital-acquired Clostridioides difficile infection (HA-CDI) is a major infection control challenge. Using whole-genome sequencing, <40% of HA-CDI cases have been estimated to have been acquired from other inpatient cases. Huge regional variations have been described depending on the prevalence of epidemic ribotypes. We hypothesized that, according to the geographical area, variations in HA-CDI rates between hospitals could be attributable either to differences in infection control policies or to antimicrobial consumption. Objectives: To assess the association of HA-MRSA rates (a surrogate marker of infection control policies) and antimicrobial consumption with HA-CDI incidence from 2011 to 2018 in hospitals reporting at the VINCat-program (Infection Control and Antimicrobial Stewardship Catalan Program). Methods: Data on 45 hospitals in Catalonia (with 70.5% of all adult acute-care hospital beds) reporting antimicrobial consumption, HA-MRSA, and HA-CDI new cases to the VINCat-program since 2011 to 2018 were analyzed. To report antimicrobial consumption, the Anatomical Therapeutic Chemical Classification (ATC) defined daily dose (DDD) index 2018 was used. Participating hospitals were classified into 3 groups according to size: group 1 (>500 beds), 9 hospitals; group 2 (500–200 beds), 15 hospitals; and group 3 (<200 beds), 21 hospitals. The number of hospitalization days recorded at the participating hospitals increased from 2,828,101 in 2011 to 3,201,680 in 2018. To analyze the association between HA-MRSA rate, antimicrobial consumption and the rate of CDI-HA, a Poisson regression model was used. HA-CDI annually new cases have been defined as a dependent variable, the stays as an offset of the model and the HA-MRSA rates and antimicrobial consumption (measured in DDD) as independent factors. The exponents of model coefficients are equal to incidence rate ratios (IRR). Results: The regression model showed an association of with antimicrobial consumption with HA-CDI (IRR,1.05; 95% CI, 1.03–1.07; P < .001) and a lack of association with HA-MRSA (IRR, 0.83; 95% CI, 0.46–1.48; P = .52). Conclusions: The HA-CDI incidence rate grew annually by 5% for an increase of 1 DDD in annual antibiotic consumption. No association HA-MRSA rates was detected, suggesting that antimicrobial stewardship programs are urgently needed to improve the control of HA-CDI in Catalonia, a geographical area with a low prevalence of epidemic ribotypes.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.

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COVID-19 in Youth Soccer During Summer 2020

Journal of Athletic Training ◽

10.4085/610-20 ◽

2021 ◽

Author(s):

Andrew M. Watson ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

Bethany Stevens ◽

...

Keyword(s):

United States ◽

Risk Reduction ◽

Incidence Rate ◽

Negative Binomial ◽

Risk Mitigation ◽

Negative Binomial Regression ◽

The United States ◽

Incidence Rates ◽

Negative Binomial Regression Model ◽

Youth Soccer

ABSTRACT Context: As sports reinitiate around the country, the incidence of COVID-19 among youth soccer athletes remains unknown. Objective: To determine the incidence of COVID-19 among youth soccer athletes and the risk mitigation practices utilized by youth soccer organizations. Design: Retrospective cohort. Participants: Youth soccer club directors throughout the United States. Main Outcome Measures: Surveys were completed in late August 2020 regarding phase of return to soccer (individual only, group non-contact, group contact), date of reinitiation, number of players, cases of COVID-19, and risk reduction procedures being implemented. Case and incidence rates were compared to national pediatric data and county data from the prior 10 weeks. A negative binomial regression model was developed to predict club COVID-19 cases with local incidence rate and phase of return as covariates and the log of club player-days as an offset. Results: 124 respondents had reinitiated soccer, representing 91,007 players with a median duration of 73 days (IQR: 53-83 days) since restarting. Of the 119 that had progressed to group activities, 218 cases of COVID-19 were reported among 85,861 players. Youth soccer players had a lower case rate and incidence rate than children in the US (254 v. 477 cases per 100,000; incidence rate ratio [IRR]=0.511, 95% CI = [0.40-0.57], p<0.001) and the general population from the counties where data was available (268 v. 864 cases per 100,000; IRR=0.202 [0.19–0.21], p<0.001). After adjusting for local COVID-19 incidence, there was no relationship between club COVID-19 incidence and phase of return (non-contact: b=0.35±0.67, p=0.61; contact: b=0.18±0.67, p=0.79). Soccer clubs reported utilizing a median of 8 (IQR: 6-10) risk reduction procedures. Conclusions: The incidence of COVID-19 among youth soccer athletes is relatively low when compared to the background incidence among children in the United States in summer of 2020. No relationship was identified between club COVID-19 incidence and phase of return to soccer.

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