Sponsors asked the IOM's Food and Nutrition Board and the Division of Behavioral and Social Sciences and Education Board on Children, Youth, and Families to review and update the IOM (1990) recommendations for weight gain during pregnancy and recommend ways to encourage their adoption through consumer education, strategies to assist practitioners, and public health strategies.The committee was asked to address the following tasks: 1. Review evidence on the relationship between weight gain patterns before, during, and after pregnancy and maternal and child health outcomes, with particular attention to the prevalence of maternal obesity racial/ethnic and age differences, components of GWG, and implications of weight during pregnancy on postpartum weight retention, maternal and child obesity, and later child health. 2. Within a life-stage framework consider factors in relation to GWG that are associated with maternal health outcomes such as lactation performance, postpartum weight retention, cardiovascular disease, metabolic processes including glucose and insulin-related issues, and risk of other chronic diseases; for infants and children, in addition to low birth weight, consider early developmental impacts and obesity-related consequences (e.g., mental health, diabetes). 3. Recommend revisions to the existing guidelines, where necessary, including the need for specific pregnancy weight guidelines for underweight, normal weight, and overweight and obese women and adolescents and women carrying twins or higher-order multiples. 4. Consider a range of approaches to promote appropriate weight gain, including: individual (behavior), psychosocial, community, health care, and health systems; timing and components of interventions; and ways to enhance awareness and adoption of the guidelines, including interdisciplinary approaches, consumer education to men and women, strategies to assist practitioners to use the guidelines, and public health strategies. 5. Identify gaps in knowledge and recommend research priorities.

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Weight Gain During Pregnancy: Reexamining the Guidelines

CONTEXT In the United States, young people aged 15–24 represent 25% of the sexually experienced population. However, the incidence and prevalence of sexually transmitted diseases (STDs) among this age-group are unknown.

METHODS Data from a variety of sources were used to estimate the incidence and prevalence of STDs among 15–24-year-olds in the United States in 2000. The quality and reliability of the estimates were categorized as good, fair or poor, depending on the quality of the data source.

RESULTS Approximately 18.9 million new cases of STD occurred in 2000, of which 9.1 million (48%) were among persons aged 15–24. Three STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15–24-year-olds.

CONCLUSIONS These estimates emphasize the toll that STDs have on American youth. More representative data are needed to help monitor efforts at lowering the burden of these infections.

https://onlinelibrary.wiley.com/doi/pdf/10.1363/3600604

Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000.

Combination antiretroviral therapy (CART) has greatly reduced medical morbidity and mortality with HIV infection, but high rates of HIV-associated neurocognitive disorders (HAND) continue to be reported. Because large HIV-infected (HIV+) and uninfected (HIV−) groups have not been studied with similar methods in the pre-CART and CART eras, it is unclear whether CART has changed the prevalence, nature, and clinical correlates of HAND. We used comparable methods of subject screening and assessments to classify neurocognitive impairment (NCI) in large groups of HIV + and HIV − participants from the pre-CART era (1988–1995; N = 857) and CART era (2000–2007; N = 937). Impairment rate increased with successive disease stages (CDC stages A, B, and C) in both eras: 25%, 42%, and 52% in pre-CART era and 36%, 40%, and 45% in CART era. In the medically asymptomatic stage (CDC-A), NCI was significantly more common in the CART era. Low nadir CD4 predicted NCI in both eras, whereas degree of current immunosuppression, estimated duration of infection, and viral suppression in CSF (on treatment) were related to impairment only pre-CART. Pattern of NCI also differed: pre-CART had more impairment in motor skills, cognitive speed, and verbal fluency, whereas CART era involved more memory (learning) and executive function impairment. High rates of mild NCI persist at all stages of HIV infection, despite improved viral suppression and immune reconstitution with CART. The consistent association of NCI with nadir CD4 across eras suggests that earlier treatment to prevent severe immunosuppression may also help prevent HAND. Clinical trials targeting HAND prevention should specifically examine timing of ART initiation.

/pdf/hiv-associated-neurocognitive-disorders-before-and-during-y4m6pmmr7o.pdf

HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors

Escherichia coli O157:H7 causes 73,000 illnesses in the United States annually. We reviewed E. coli O157 outbreaks reported to Centers for Disease Control and Prevention (CDC) to better understand the epidemiology of E. coli O157. E. coli O157 outbreaks (>2 cases of E. coli O157 infection with a common epidemiologic exposure) reported to CDC from 1982 to 2002 were reviewed. In that period, 49 states reported 350 outbreaks, representing 8,598 cases, 1,493 (17%) hospitalizations, 354 (4%) hemolytic uremic syndrome cases, and 40 (0.5%) deaths. Transmission route for 183 (52%) was foodborne, 74 (21%) unknown, 50 (14%) person-to-person, 31 (9%) waterborne, 11 (3%) animal contact, and 1 (0.3%) laboratory-related. The food vehicle for 75 (41%) foodborne outbreaks was ground beef, and for 38 (21%) outbreaks, produce.

/pdf/epidemiology-of-escherichia-coli-o157-h7-outbreaks-united-4tcudil557.pdf

Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982-2002.

Fresh produce: a growing cause of outbreaks of foodborne illness in the United States, 1973 through 1997.

In fall 1996, a small cluster of Escherichia coli O157:H7 infections was linked to unpasteurized apple juice. This study found that standard procedures at a plant that produces unpasteurized juices...

An outbreak of Escherichia coli O157:H7 infection from unpasteurized commercial apple juice.

For adults and adolescents (i.e., persons aged >/=13 years), the human immunodeficiency virus (HIV) infection classification system and the surveillance case definitions for HIV infection and acquired immunodeficiency syndrome (AIDS) have been revised and combined into a single case definition for HIV infection. In addition, the HIV infection case definition for children aged <13 years and the AIDS case definition for children aged 18 months to <13 years have been revised. No changes have been made to the HIV infection classification system, the 24 AIDS-defining conditions for children aged <13 years, or the AIDS case definition for children aged <18 months. These case definitions are intended for public health surveillance only and not as a guide for clinical diagnosis. Public health surveillance data are used primarily for monitoring the HIV epidemic and for planning on a population level, not for making clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection and AIDS using the 2008 surveillance case definitions, effective immediately.

/pdf/revised-surveillance-case-definitions-for-hiv-infection-48riu6jy6r.pdf

Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years--United States, 2008.

Despite state and local laws requiring medical providers to report notifiable infectious diseases to public health authorities, reporting is believed to be incomplete. Through means of an analytical literature review, the authors synthesize current knowledge on the completeness of disease reporting and identify factors associated with reporting completeness. The review was limited to published studies, conducted in the United States between 1970 and 1999, that quantitatively assessed infectious disease reporting completeness. Thirty-three studies met the inclusion criteria. Reporting completeness, expressed between 0% and 100%, was treated as the dependent outcome variable in statistical analysis; disease, study location, time period, study design, and study size were treated as independent variables. Fifty-six distinct measures of reporting completeness were identified for 21 diseases. Reporting completeness varied from 9% to 99% and was most strongly associated with the disease being reported. The mean reporting completeness for acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis as a group was significantly higher (79%) than for all other diseases combined (49%) (p < 0.01).

/pdf/completeness-of-notifiable-infectious-disease-reporting-in-1iziupyc08.pdf

Completeness of notifiable infectious disease reporting in the United States: an analytical literature review.

Recommendations and Reports

High seroprevalence rates for Helicobacter pylori are reported in developing countries, yet few seroincidence studies exist that determine age of initial acquisition and risk factors for H. pylori seroconversion. Two H. pylori serosurveys were conducted in August 1996 and November 1997. Of 188 children aged 21 months to 6 years who were seronegative in the first survey, 44 (23%) had seroconverted at follow-up, yielding an 18% annual seroincidence. The largest increase in seroincidence occurred between children aged 2 years (10%) and children aged 3 years (32%). Use of a lidded, narrow-mouthed water vessel was protective against seroconversion (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.1-0.8), and the presence of another H. pylori-seropositive sibling in the household was a risk factor for seroconversion (OR, 3.1; 95% CI, 1.3-8.7). Although not a randomized intervention trial, this study suggests that the use of a narrow-mouthed water vessel may prevent the transmission of H. pylori in households in developing countries.

/pdf/seroincidence-of-helicobacter-pylori-infection-in-a-cohort-57ewil15s5.pdf

M. Kathleen Glynn

Papers

An outbreak of Escherichia coli O157:H7 infection from unpasteurized commercial apple juice.

Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years--United States, 2008.

Completeness of notifiable infectious disease reporting in the United States: an analytical literature review.

Recommendations and Reports

Seroincidence of Helicobacter pylori Infection in a Cohort of Rural Bolivian Children: Acquisition and Analysis of Possible Risk Factors