The authors of the article published in this issue of AIDS should be complimented on their study focusing on recent hospitalizations of HIV patients in South Africa . It is impressive that most of the patients had suppressed HIV RNA levels, and it is a tribute to the excellent care and effective antiretroviral therapy that these patients received. As a doctor who cared for the very first AIDS patients in Delaware beginning in 1981, it was reassuring that so few hospitalizations in this study were due to AIDS-defining illnesses, and that most cases of hospitalization due to AIDS-defining illnesses were associated with M. tuberculosis, not other opportunistic infections or malignancies.

The paper includes some interesting results that deserve to be highlighted. Of the 99 virally suppressed patients with HIV infection who were hospitalized, 27 patients had AIDS-defining conditions. The vast majority of these (22/27 or 82%) had active tuberculosis (TB). The median CD4+ lymphocyte count of the virally suppressed patients was almost 400, so these patients would not, by conventional laboratory criteria, be severely immunocompromised, especially since acute illness (including TB) is known to itself cause lymphopenia in HIV-uninfected patients . Only a small number of virally suppressed patients in this study had other AIDS-defining illnesses and included 2 cases of HIV-related non-Hodgkin's lymphoma, one case of disseminated Kaposi sarcoma, one case of recurrent cryptosporidium diarrhea, and a single case of disseminated Mycobacterium avium complex.

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Key Points

Question  What were the burden and transmission patterns of influenza, mumps, and hepatitis A in US Immigration and Customs Enforcement detention facilities from 2019 to 2023, and what risks did they pose to detained migrants and staff?

Findings  This case series of 20 facilities found that influenza (2035 cases), mumps (252 cases), and hepatitis A (486 cases) were all prevalent with varying seasonality and multiple facility outbreaks, reflecting the risk profiles for respiratory and enteric infectious diseases of persons entering detention.

Meaning  On the basis of these findings, decongregation, control of facility crowding, and vaccination programs are recommended approaches to reduce transmission risks for incarcerated migrants and facility employees.

Abstract

Importance  Migrants detained by US Immigration and Customs Enforcement (ICE) are at risk of preventable infections from crowding and limited health care. Postpandemic risk remains unclear as detention increases.

Objective  To assess epidemiological patterns of 3 vaccine-preventable diseases within ICE facilities.

Design, Setting, and Participants  This case series study examined data from January 2019 through October 2023 from ICE facilities managed by ICE Health Services Corp during the study period. All cases of influenza, mumps, and hepatitis A among persons detained in reporting ICE facilities were included.

Exposure  Diagnosis of influenza, mumps, or hepatitis A during ICE detention.

Main Outcomes and Measures  The primary outcomes were monthly case counts and estimated case rates (per 100 000 person-months), outbreak occurrence and duration, and seasonal and geospatial patterns. Outbreaks were defined as 3 or more cases within a facility over at least 1 month. Seasonal variation was assessed through variations in mean monthly case rates across years with analysis of variance, and Tukey tests were used to compare monthly pairwise permutations for statistical significance. Geospatial trends were evaluated using global and local Moran I analyses of annual facility-level case rates.

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Abstract

Objectives. To evaluate site-specific testing and isolation procedures for preventing on-site SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infections among unaccompanied migrant children in federal congregate care settings. Methods. From August 2021 to May 2023, the Increasing Community Access to Testing, Treatment, and Response (ICATT) program administered 385 234 rapid antigen and nucleic acid amplification tests to 68 674 children at 2 emergency intake sites in Texas. We used logistic regression, the χ2 test, and Kaplan-Meier survival analysis to estimate the number of infections acquired on-site and the number of cases prevented via implementation of ICATT comprehensive testing and isolation protocols. Results. ICATT protocols identified 83% of cases at intake, and our analyses projected that 92% of cases were isolated before on-site transmission could occur. Testing and isolation measures prevented an estimated 1335 to 2377 on-site infections, reducing caseloads by 15% to 23% and transmission by 68% to 79%. Conclusions. Site-specific, algorithmic testing and isolation protocols substantially reduced SARS-CoV-2 transmission among children in federal congregate care settings. Public Health Implications. Enhanced testing and isolation strategies should be considered to mitigate within-facility transmission among temporary residents in congregate care settings. (Am J Public Health. Published online ahead of print July 2, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308488).