Showing papers in "Morbidity and Mortality Weekly Report in 2000"

Surveillance for foodborne-disease outbreaks--United States, 1993-1997.

Abstract: Problem/condition Since 1973, CDC has maintained a collaborative surveillance program for collection and periodic reporting of data on the occurrence and causes of foodborne-disease outbreaks (FBDOs) in the United States. Reporting period covered This summary reviews data from January 1993 through December 1997. Description of system The Foodborne-Disease Outbreak Surveillance System reviews data concerning FBDOs, defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. State and local public health departments have primary responsibility for identifying and investigating FBDOs. State, local, and territorial health departments use a standard form to report these outbreaks to CDC. Results During 1993-1997, a total of 2,751 outbreaks of foodborne disease were reported (489 in 1993, 653 in 1994, 628 in 1995, 477 in 1996, and 504 in 1997). These outbreaks caused a reported 86,058 persons to become ill. Among outbreaks for which the etiology was determined, bacterial pathogens caused the largest percentage of outbreaks (75%) and the largest percentage of cases (86%). Salmonella serotype Enteritidis accounted for the largest number of outbreaks, cases, and deaths; most of these outbreaks were attributed to eating eggs. Chemical agents caused 17% of outbreaks and 1% of cases; viruses, 6% of outbreaks and 8% of cases; and parasites, 2% of outbreaks and 5% of cases. Interpretation The annual number of FBDOs reported to CDC did not change substantially during this period or from previous years. During this reporting period, S. Enteritidis continued to be a major cause of illness and death. In addition, multistate outbreaks caused by contaminated produce and outbreaks caused by Escherichia coli O157:H7 remained prominent. Actions taken Current methods to detect FBDOs are improving, and several changes to improve the ease and timeliness of reporting FBDO data are occurring (e.g., a revised form to simplify FBDO reporting by state health departments and electronic reporting methods). State and local health departments continue to investigate and report FBDOs as part of efforts to better understand and define the epidemiology of foodborne disease in the United States. At the regional and national levels, surveillance data provide an indication of the etiologic agents, vehicles of transmission, and contributing factors associated with FBDOs and help direct public health actions to reduce illness and death caused by FBDOs.

Surveillance for Lyme disease--United States, 1992-1998.

Abstract: Problem/condition Lyme disease is caused by infection with the spirochete Borrelia burgdorferi and is the most commonly reported vector-borne disease in the United States. Borrelia burgdorferi is transmitted to humans by infected Ixodes scapularis and I. pacificus ticks. Lyme disease is typically evidenced in its early stage by a characteristic rash (erythema migrans), accompanied by nonspecific symptoms (e.g., fever, malaise, fatigue, headache, myalgia, and arthralgia). Lyme disease can usually be treated successfully with standard antibiotic regimens. Reporting period 1992-1998. Description of system Lyme disease surveillance data are reported to CDC through the National Electronic Telecommunication System for Surveillance, a computerized public health database for nationally notifiable diseases. During 1992-1998, data regarding reported cases of Lyme disease included county and state of residence, age, sex, and date of onset. Descriptive analyses were performed, and cumulative incidence by state, county, age group, and sex were calculated. Results During 1992-1998, a total of 88,967 cases of Lyme disease was reported to CDC by 49 states and the District of Columbia, with the number of cases increasing from 9,896 in 1992 to 16,802 in 1998. A total of 92% of cases was reported from eight northeastern and mid-Atlantic states and two north-central states. Children aged 5-9 years and adults aged 45-54 years had the highest mean annual incidence. Interpretation Lyme disease is a highly focal disease, with the majority of reported cases occurring in the northeastern and north-central United States. The number of reported cases of Lyme disease increased during 1992-1998. Geographic and seasonal patterns of disease correlate with the distribution and feeding habits of the vector ticks, I. scapularis and I. pacificus. Public health action The results presented in this report will help clinicians evaluate the prior probability of Lyme disease and provide the framework for targeting human Lyme disease vaccine use and other prevention and treatment interventions.

Biological and chemical terrorism: strategic plan for preparedness and response.

Abstract: 1. Include terrorism in your crisis management plan with a subsection that addresses biological and chemical attacks 2. Provide training for all personnel 3. Provide specialized training for first responders 4. Practice response to emergencies 5. Document activities and follow up on noted deficiencies 6. Review the recommendations of the Center for Disease Control Strategic Planning Workgroup, provide on the following pages.

Multistate outbreak of listeriosis - United States, 2000.

Abstract: Since May 2000, 29 illnesses caused by a strain of Listeria monocytogenes (LM) have been identified in 10 states: New York (15 cases); Georgia (three); Connecticut, Ohio, and Michigan (two each); and California, Pennsylvania, Tennessee, Utah, and Wisconsin (one each). Dates of LM isolation ranged from May 17 through November 26 with 26 (90%) infections occurring since July 15. When subtyped, the LM isolates from these cases were indistinguishable by pulsed-field gel electrophoresis (PulseNet pattern numbers GX6A16.0014 by Asc1 and GX6A12.0017 by Apa1) and ribotyping (DUP-1053). This report summarizes the investigation, which linked these cases of listeriosis to eating deli turkey meat.

Preventing congenital toxoplasmosis

Abstract: Scope of the problem Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. Acute infections in pregnant women can be transmitted to the fetus and cause severe illness (e.g., mental retardation, blindness, and epilepsy). An estimated 400-4,000 cases of congenital toxoplasmosis occur each year in the United States. Of the 750 deaths attributed to toxoplasmosis each year, 375 (50%) are believed to be caused by eating contaminated meat, making toxoplasmosis the third leading cause of foodborne deaths in this country. Etiologic factors Toxoplasma can be transmitted to humans by three principal routes: a) ingestion of raw or inadequately cooked infected meat; b) ingestion of oocysts, an environmentally resistant form of the organism that cats pass in their feces, with exposure of humans occurring through exposure to cat litter or soil (e.g., from gardening or unwashed fruits or vegetables); and c) a newly infected pregnant woman passing the infection to her unborn fetus. RECOMMENDATIONSFOR PREVENTION: Toxoplasma infection can be prevented in large part by a) cooking meat to a safe temperature (i.e., one sufficient to kill Toxoplasma); b) peeling or thoroughly washing fruits and vegetables before eating; c) cleaning cooking surfaces and utensils afterthey have contacted raw meat, poultry, seafood, or unwashed fruits or vegetables; d) pregnant women avoiding changing cat litter or, if no one else is available to change the cat litter, using gloves, then washing hands thoroughly; and e) not feeding raw or undercooked meat to cats and keeping cats inside to prevent acquisition of Toxoplasma by eating infected prey. Research agenda Priorities for research were discussed at a national workshop sponsored by CDC in September 1998 and include a) improving estimates of the burden of toxoplasmosis, b) improving diagnostic tests to determine when a person becomes infected with Toxoplasma, and c) determining the applicability of national screening programs. Conclusion Many cases of congenital toxoplasmosis can be prevented. Specific measures can be taken by women and their health-care providers to decrease the risk for infection during pregnancy and prevent severe illness in newborn infants.

Neural tube defect surveillance and folic acid intervention - Texas-Mexico border, 1993-1998.

Abstract: Neural tube defects (NTDs) are common and serious malformations that originate early in pregnancy. In the United States, approximately 4000 pregnancies each year are affected by the two most common NTDs (spina bifida and anencephaly). In 1992, the Texas Department of Health (TDH), with support from a CDC cooperative agreement, implemented the Texas Neural Tube Defect Project (TNTDP), a program of NTD surveillance and risk-reduction activities in the 14 counties that border Mexico. The project was initiated in response to an anencephaly cluster identified during 1990-1991 in Brownsville (Cameron County), Texas (1). Whether the high anencephaly rate (19.7 per 10,000 live births) was unique to Cameron County or was characteristic of the entire border was unknown. This report summarizes NTD surveillance rates for the 14 Texas-Mexico border counties for 1993-1998 and presents preliminary results of TNTDP efforts to prevent the recurrence of NTDs by providing folic acid to high-risk women. Findings indicate that the baseline rate along the border is high (13.4 per 10,000 live births) and largely reflects the rate among Hispanics (13.8). Although a longer period is needed to obtain definitive results, folic acid appears to be effective for reducing the risk for NTD recurrence in Hispanics.

Staphylococcus aureus with reduced susceptibility to vancomycin - Illinois, 1999.

Abstract: Staphylococcus aureus is one of the most common causes of hospital- and community-acquired infections. Nosocomial methicillin-resistant S. aureus (MRSA) infections have become common, and cases of community-acquired MRSA infections also have occurred. Since 1996, vancomycin-intermediate S. aureus (VISA; vancomycin minimum inhibitory concentration [MIC = 8-16 microg/mL) has been identified in Europe, Asia, and the United States. The emergence of reduced vancomycin susceptibility in S. aureus increases the possibility that some strains will become fully resistant and that available antimicrobial agents will become ineffective for treating infections caused by such strains. This report describes the fourth case of confirmed VISA from a patient in the United States.

Tobacco use among middle and high school students--United States, 1999.

Abstract: Tobacco Use — Continued The prevalence of cigarette smoking nationwide among high school students increased during the 1990s (1); more than 80% of current adult tobacco users started smoking cigarettes before age 18 years (2). To determine the prevalence of cigarette, smokeless tobacco (i.e., chewing tobacco and snuff), cigar, pipe, bidi, and kretek use among middle school and high school students nationwide, the American Legacy Foundation, in collaboration with the CDC Foundation, conducted the National Youth Tobacco Survey (NYTS) during the fall of 1999. This report summarizes data from the NYTS on current use of tobacco products, which indicate that 12.8% of middle school students and 34.8% of high school students use any type of tobacco; that the low prevalence of current cigarette smoking observed among black high school students throughout the 1990s is not found among middle school students (1); and that the percentages of high school students who currently use bidis and kreteks (two new forms of tobacco in the United States) are almost as high as the proportion who use smokeless tobacco. The school-based 1999 NYTS employed a three-stage cluster sample designed to produce a nationally representative sample of students in grades 6–12. The first-stage sampling frame contained 1306 primary sampling units (PSUs), each comprising a large county or a group of smaller adjacent counties. From the 1306 PSUs, 66 were selected from 16 strata formed on the basis of the degree of urbanization and the relative percentage of black and Hispanic students in the PSU. PSUs were selected with probability proportional to weighted school enrollment. At the second sampling stage, 145 schools from the 66 PSUs were selected with probability proportional to weighted school enrollment. To ensure separate analysis of black and Hispanic students , schools with substantial numbers of black and Hispanic students were sampled at higher rates than all other schools through a weighted measure of size. The third stage of sampling consisted of randomly selecting approximately five intact classes of a required subject (e.g., English or social studies) across grades 6–12 from each participating school. All students in the selected classes were eligible to participate. A weighting factor was applied to each student record to adjust for nonresponse and for the varying probabilities of selection, including those resulting from the oversampling of black and Hispanic students. Numbers of students in racial/ethnic groups other than black, white, and Hispanic were too small for meaningful …

Adoption of protective behaviors among persons with recent HIV infection and diagnosis - Alabama, New Jersey, and Tennessee, 1997-1998.

Abstract: A comprehensive human immunodeficiency virus (HIV) prevention strategy includes knowledge of HIV status, counseling to reduce high-risk behavior, and referral for appropriate care (1). After diagnosis, a substantial percentage of HIV-infected persons reduce their high-risk sexual behaviors (2-4). This report presents data characterizing the sexual practices of persons with newly diagnosed HIV infection who have evidence of recently acquired infection. Characterizing these persons may assist in the development of risk-reduction efforts for HIV-infected populations to prevent further HIV transmission.

Blood lead levels in young children - United States and selected states, 1996-1999.

Abstract: Lead exposure adversely affects the cognitive development and behavior of young children (1). For children aged < 6 years, CDC has defined an elevated blood lead level (BLL) as > or = 10 microg/dL, but evidence exists for subtle effects at lower levels (2). Data from CDC's Third National Health and Nutrition Examination Survey, Phase 2 (1991-1994) (NHANES) showed that average BLLs in children had decreased approximately 80% since the late 1970s but that elevated BLLs remained more common among low-income children, urban children, and those living in older housing (3,4). Although these data provide national estimates of the prevalence of elevated BLLs among children, they do not provide information at the state or local level. To target prevention efforts and monitor progress toward reducing BLLs at the state and local level, CDC's Childhood Blood Lead Surveillance (CBLS) program supports state blood lead surveillance programs on the basis of blood lead tests from public and private clinical laboratories. This report summarizes data on BLLs in children aged 1-5 years from NHANES data collected in 1999 and children aged < 6 years from state surveillance data provided to CDC by 19 state surveillance programs during 1996-1998. The findings indicate that, despite the decreases in mean BLL among children, the problem remains concentrated on a local level. Surveillance efforts should be used to target screening efforts to communities at highest risk.

Influenza, pneumococcal, and tetanus toxioid vaccination of adults--United States, 1993-7.

Abstract: PROBLEM/CONDITION An increasing proportion of adults have received recommended vaccinations against influenza, pneumococcal infection, and tetanus. However, in 1995, fewer than 60% of adults were vaccinated as recommended. REPORTING PERIOD COVERED 1993-1997. DESCRIPTION OF SYSTEM Data were obtained from the state-based Behavioral Risk Factor Surveillance System (BRFSS) for 1993, 1995, and 1997 and from the National Health Interview Survey (NHIS) for 1995 to describe national, regional, and state-specific patterns of use of influenza and pneumococcal vaccines and tetanus toxoid among noninstitutionalized adults aged > or = 18 years. RESULTS Among adults aged > or = 65 years in 1995, 58% reported receiving an influenza vaccination during the previous 12 months, and 34% reported ever receiving a pneumococcal vaccination. In this age group, non-Hispanic whites were more likely to report receipt of influenza (61%) and pneumococcal vaccines (36%) than non-Hispanic blacks (40% and 22%, respectively) and Hispanics (50% and 23%, respectively). Among the 50 states and the District of Columbia, the median vaccination level among older adults (i.e., persons aged > or = 65 years) increased from 51% in 1993 to 66% in 1997 for influenza vaccine, and from 28% in 1993 to 46% in 1997 for pneumococcal vaccine. Adults with chronic medical conditions had low vaccination levels. Those aged 50-64 years were more likely than those aged 18-49 years to report influenza (38% versus 20%) and pneumococcal vaccination (20% versus 12%). In 1995, the proportion of adults who reported receiving a tetanus vaccination during the previous 10 years decreased with age, from 65% among those aged 18-49 years to 54% among those aged 50-64 years and to 40% among those aged > or = 65 years. In each age group, women were less likely than men to report receiving tetanus toxoid; and among adults aged > or = 65 years, Hispanics and Asians/Pacific Islanders were least likely among all racial/ethnic groups to report receiving tetanus toxoid. INTERPRETATION By 1995, the Healthy People 2000 objective to increase to at least 60% the proportion of persons aged > or = 65 years who had received annual influenza vaccination had been achieved among non-Hispanic whites (objective 20.11). However, substantial improvement is needed among non-Hispanic blacks, Hispanics, and adults aged < 65 years with high-risk medical conditions. PUBLIC HEALTH ACTIONS Continued surveillance of vaccine coverage among adults will direct attention to undervaccinated populations that may be disproportionately affected by vaccine-preventable diseases. Vaccination coverage data can be used to guide efforts to increase awareness among health-care providers and the public about the benefits of vaccination, establish systems to ensure that every contact with the health-care system is used to update vaccinations, and further support financial mechanisms to increase vaccine delivery.

Outbreak of Rift Valley fever - Saudi Arabia, August-October, 2000.

Abstract: On September 10 2000 the Ministry of Health (MOH) of Saudi Arabia and subsequently the MOH of Yemen received reports of unexplained hemorrhagic fever in humans and associated animal deaths from the southwestern border of both countries. Signs and symptoms of ill persons included low grade fever abdominal pain vomiting diarrhea jaundice with liver and renal dysfunction often progressing to disseminated intravascular coagulation hepatorenal syndrome and death. This paper summarizes the preliminary results of the collaborative epidemiologic investigation performed by the Saudi Arabian MOH and other health institutions of the first confirmed occurrence of Rift Valley Fever (RVF) outside Africa. 316 persons with suspected severe RVF have been hospitalized for care and management. Of the 316 patients 245 (78%) were male; the median age was 46 years; 15 were aged <16 years; 253 (80%) were Saudi and 63 (20%) were Yemeni citizens. At least 66 (21%) patients have died. Efforts of the MOH to eliminate the problem are discussed.

Outbreak of Rift Valley Fever -- Yemen August - October 2000.

Abstract: In September 2000 an outbreak of a disease compatible with Rift Valley fever (RVF) affecting humans and animals in El Zuhrah district of Hodeidah governorate Yemen was reported. In response to the epidemic the Ministry of Agriculture and Irrigation and the Ministry of Health organized a national effort to control the spread of the disease optimize management of affected persons and track the course of the outbreak. This report summarizes the findings of the case surveillance conducted among patients and animal owners. Between August and November 2000 1087 suspected case-patients were identified including 121 (11%) deaths with a mean age of 32.2 years. The clinical spectrum of the disease included patients with hemorrhagic disease encephalitis retinitis and uncomplicated RVF. Of the 1087 815 (75%) case-patients reported exposure to sick animals handling an abortus or slaughtering animals during the week prior to the onset of the illness. Of 490 case-patients with serologic testing 136 (26%) had immunoglobulin M (IgM) antibody to RVF virus. Serologically confirmed disease transmission was detected in 15 districts throughout the coastal plains and adjacent mountains. Finally a cross-sectional survey assessed the extent of transmission in animals and revealed a high prevalence of IgM antibody to RVF.

Summary of notifiable diseases - United States, 2000.

Abstract: The MMWR Summary of Notifiable Diseases, United States, 2000 contains, in tabular and graphical form, the official statistics for the reported occurrence of nationally notifiable diseases in the United States for 2000. These statistics are collected and compiled from reports to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE).

State- and sex-specific prevalence of selected characteristics--Behavioral Risk Factor Surveillance System, 1996 and 1997.

Abstract: Problem/condition High-risk behaviors (e.g., physical inactivity, cigarette smoking, and drinking and driving) and lack of preventive health care (e.g., screening for cancer) are associated with morbidity and mortality from chronic disease and injury. The Behavioral Risk Factor Surveillance System (BRFSS) collects state-specific information to determine the prevalence of such behaviors and preventive practices. By using the BRFSS, states can gain a better understanding of the factors that have a major affect on the health of their adult populations. The BRFSS is also used to monitor progress toward national health objectives. Reporting period covered 1996 and 1997. Description of system The BRFSS is a state-based telephone survey of the civilian, noninstitutionalized, adult (i.e., persons aged 18 years) population. In both 1996 and 1997, 50 states, the District of Columbia, and the Commonwealth of Puerto Rico participated in the BRFSS. Results As in previous years, state- and sex-specific variations occurred in the prevalence of high-risk behaviors, awareness of certain medical conditions, use of preventive health services, and health-care coverage. For example, in 1997, the percentage of adults who reported being current cigarette smokers ranged from 13.8% to 30.7% among states (median: 23.2%), and the percentage of adults who reported driving after drinking too much alcohol ranged from 0.6% to 5.3% (median: 1.9%). Binge drinking varied substantially not only by state (range: 6.3%-23.3%; median: 14.5%) but also by sex (men: 22.3%; women: 6.7%). Similarly, the prevalence of overweight varied considerably by sex: 62.2% of men and 44.5% of women were overweight in 1997. Interpretation The 1996 and 1997 BRFSS data demonstrate that U.S. adults engage in behaviors that are detrimental to their health. The data also demonstrate that many adults are making efforts to prevent chronic disease and injury. The prevalence of certain behaviors and health practices differs between states and between men and women. The reasons for these differences by state and sex are subjects for further analysis, but only through continued surveillance can the areas that need further study be identified. Public health actions Data from the BRFSS are useful in developing and guiding public health programs and policies. For many states, the BRFSS is the only source of state-level data on behaviors and practices related to chronic disease and injury; therefore, BRFSS data are vital for effective decision-making at the local level. States will continue to use these data to help prevent premature morbidity and mortality among their adult population and to assess progress toward national health objectives.

Update: outbreak of Rift Valley fever -- Saudi Arabia August-November 2000.

Abstract: First cases of hemorrhagic fever affecting humans and animals confirmed as Rift Valley fever (RVF) were reported to the Ministry of Health (MOH) in Saudi Arabia in September 2000 This report provides updated information on the ongoing investigation conducted by the Saudi Arabian MOH As of November 1 516 suspected case-patients with severe RVF were identified including 87 (17%) persons who have died Of the 216 suspected case-patients tested 206 (95%) revealed either viral antigen or immunoglobulin M antibody The median age of suspected case-patients was 46 years (range: 1-95 years); the majority were males Saudi citizens and came from the southwestern province of Jahan The mean duration of onset to hospitalization was 33 days and average time elapsed from disease onset among 87 fatalities was 63 days Moreover 125 (76%) of 165 case-patients reported close contact with animals and 91 (64%) of 143 reported a history of exposure to dead and/or aborted animals Nearly all persons reported having had mosquito bites Entomologic studies revealed two species of mosquitoes Culex tritaeniorrhynchus and Aedes caspius which have already been found to carry RVF virus Further investigation suggests involvement of additional Aedes species A correlation was found between areas where human cases were reported and the same flood irrigation farming identified by entomologists

Outbreak of Escherichia coli O157:H7 infection associated with eating fresh cheese curds-Wisconsin, June 1998.

Abstract: On June 15, 1998, the Division of Public Health, Wisconsin Department of Health and Family Services, was notified of eight laboratory-confirmed and four suspected Escherichia coli O157:H7 infections among west-central Wisconsin residents who became ill during June 8-12. This report summarizes the outbreak investigation, which implicated fresh (held <60 days) cheese curds from a dairy plant as the source of infection.

Fatal illnesses associated with a new world arenavirus California, 1999-2000

Abstract: The California Department of Health Services (CDHS) and the University of Texas Medical Branch (UTMB) recently identified evidence of infection with an arenavirus in three patients hospitalized with similar fatal illnesses. This report summarizes the investigation of these cases.

Youth tobacco surveillance United States, 1998-1999

Abstract: PROBLEM/CONDITION Tobacco use is the single leading preventable cause of death in the United States, accounting for approximately, 430,000 deaths each year. The prevalence of cigarette smoking nationwide among high school students increased during the 1990s, peaking in 1996-1997, then began a gradual decline. Approximately 80% of tobacco users initiate use before the age of 18 years. If the trend in early initiation of cigarette smoking continues, approximately 5 million children aged <18 years who are living today will die prematurely as adults because they began to smoke cigarettes during adolescence. The economic liability associated with tobacco use ranges from $50 billion to $73 billion per year in medical expenses alone. Because of these health and economic consequences, CDC has recommended that states establish and maintain comprehensive tobacco control programs to reduce tobacco use among youth. REPORTING PERIOD February 1998 through December 1999. DESCRIPTION OF THE SYSTEM To assist states in developing and maintaining their state-based comprehensive tobacco prevention and control programs, CDC developed the Youth Tobacco Surveillance and Evaluation System, which includes international, national, and state school-based surveys of middle school and high school students. Two components of this system are discussed--the National Youth Tobacco Survey and the state Youth Tobacco Surveys. The national survey is representative of students in the 50 states and the District of Columbia; 15,061 students in 131 schools completed questionnaires in 1999. The state surveys were first conducted in 1998, when three states participated, and in 1999, when 13 states participated (13 states conducted middle school surveys and 10 states conducted high school surveys); state sample sizes ranged from 452 to 15,478 students. This report summarizes data from the 1999 national survey and the 1998 and 1999 state surveys. RESULTS AND INTERPRETATION Findings from the National Youth Tobacco Survey show current tobacco use ranges from 12.8% among middle school students to 34.8% among high school students. Cigarette smoking is the most prevalent form of tobacco used, followed by cigars and smokeless tobacco. Young people have strong cigarette brand preferences. Almost half of current smokers in both middle school and high school report that they usually smoke Marlboro cigarettes. Black students are more likely to smoke Newport cigarettes than any other brand. Half of current smokers in middle school and high school report that they want to completely stop smoking. Nearly one fourth of middle school and high school students who have never smoked cigarettes indicate that they are susceptible to initiating smoking in the next year. Environmental tobacco smoke exposure is very high among both middle school and high school students. During the week before the survey, approximately 9 out of 10 current smokers and half of never smokers were in the same room with someone who was smoking; 8 out of 10 current smokers and 3 out of 10 never smokers rode in a car with someone who was smoking. Six out of 10 current smokers and 3 out of 10 never smokers live in a home where someone else smokes cigarettes. Approximately 70% of middle school and 60% of high school students who currently smoke and are aged <18 years were not asked to show proof of age when they purchased cigarettes. Approximately three fourths of middle school and high school students have seen antismoking commercials; however, 90% report having seen actors smoking on television or in the movies. Approximately 2% of middle school and high school students who had never used tobacco would wear or use something with a tobacco company name or picture on it. This rate increases to approximately 20% for current tobacco users. ACTIONS TAKEN Youth Tobacco Survey data are used by health and education officials to improve national and state programs to prevent and control youth tobacco use. (ABSTRACT TRUN

Serogroup W-135 meningococcal disease among travelers returning from Saudi Arabia - United States, 2000.

Abstract: On April 9, 2000, CDC was notified by national public health agencies in several European countries of cases of serogroup W-135 meningococcal disease among pilgrims returning from the Hajj in Mecca and their close contacts. As of April 20, 2000, the New York City Department of Health had reported three cases of serogroup W-135 meningococcal disease in the United States.

Prevalence of intimate partner violence and injuries --Washington 1998.

Abstract: This paper reports on the prevalence of intimate partner violence (IPV) and injuries in Washington State (US) in 1998. Data on the prevalence of IPV were obtained by adding questions from the Conflict Tactics Scale and the Revised Conflict Tactics Scale to the 1998 Behavioral Risk Factor Surveillance System (BRFSS) of the State Department of Health. Results showed that among the approximately 2113000 women aged 18 and older about 499000 (23.6%) experienced IPV during their lives and 456000 (21.6%) sustained a physical injury from IPV. For the 2049000 men approximately 336000 (16.4%) experienced IPV and about 154000 (7.5%) sustained injury from it. These findings indicate that IPV in Washington is more prevalent among women than men. In addition divorced or separated status and low education are shown to be associated with an increased risk for reported IPV. Implications for interventions and usefulness of BRFSS for collecting data on IPV are discussed.

Early-onset group B streptococcal disease-United States, 1998-1999.

Abstract: Despite recent declines, early-onset group B streptococcus (GBS) is a leading cause of neonatal sepsis, resulting in approximately 2200 infections each year among children aged <7 days in the United States (1). To identify opportunities for improved prevention, the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network reviewed birth histories of infants with early-onset GBS disease. This report summarizes the results of this analysis and indicates that most mothers of infants with early-onset disease did not receive intrapartum antibiotics and that further declines in disease incidence are likely with better prevention efforts. To prevent perinatal GBS disease, two strategies are recommended: the risk-based and the screening-based approach (2–4). Under the risk-based approach, women in labor who have risk factors for GBS transmission (e.g., fever, prolonged rupture of the membranes, or preterm delivery) are offered intrapartum chemoprophylaxis. Under the screening-based approach, all pregnant women are tested for GBS carriage between 35–37 weeks' gestation by collecting vaginal and rectal combined swabs, and GBS carriers are offered intrapartum chemoprophylaxis. Birth histories of infants with early-onset GBS disease in 1998 and 1999 were evaluated to determine whether cases might have been prevented by either of these strategies. A case of early-onset GBS disease was defined as the isolation of group B strepto-cocci from a normally sterile site from an infant aged <7 days born to a resident of the ABCs surveillance area and Tennessee). To assess the quality of early-onset GBS disease intervention, surveillance staff reviewed prenatal GBS screening , risks for infection at the time of labor, receipt of intrapartum antibiotics, and infant outcome. In Connecticut, prenatal provider records also were reviewed. The incidence of early-onset disease was calculated using live birth data for 1997 from the National Center for Health Statistics. Surveillance reports indicated 190 cases of early-onset GBS disease in 1998 and 153 cases in 1999 (Table 1). Maternal labor and delivery records were available for 181 (96%) infants in 1998 and 141 (92%) infants in 1999. The case fatality ratio was 5%. In 1999, the incidence of disease was 0.7 per 1000 live births among black infants, 0.5 among Hispanic infants, and 0.3 among white infants. Prenatal GBS testing was documented in 104 (35%) of 322 women; 36 (35%) had a positive result (Table 2). Among the 82 women who had documented dates of screening and gestational age at delivery, 52 (63%) were screened after 33 weeks of pregnancy. GBS …

Fluoroquinolone-resistance in Neisseria gonorrhoeae, Hawaii, 1999, and decreased susceptibility to azithromycin in N. gonorrhoeae, Missouri, 1999.

Abstract: In 1999, 360,076 cases of gonorrhea were reported in the United States (1). Gonorrhea is a major cause of pelvic inflammatory disease, often leading to ectopic pregnancy and infertility, and it can facilitate human immunodeficiency virus (HIV) transmission (2). During the 1980s, resistance to penicillin and tetracycline among gonococcal isolates became widespread; as a result, CDC recommended that other antimicrobial agents be used to treat gonorrhea. This report summarizes investigations of an increase in fluoroquinolone-resistant Neisseria gonorrhoeae in Hawaii and of a cluster of N. gonorrhoeae infections with decreased susceptibility to azithromycin in Missouri.

Update: Clostridium novyi and unexplained illness among injecting-drug users - Scotland, Ireland, and England, April-June 2000.

Abstract: Since April 19, 2000, health authorities in Scotland, Ireland, England, and the United States have been investigating an outbreak of unexplained illness and death among injecting-drug users (IDUs) in the United Kingdom and Ireland (1-3). Initial testing of specimens from 76 IDUs identified Clostridium species in 18 (24%) patients; nine were Clostridium novyi. This report updates the investigation of this outbreak, which indicates that Clostridium species may be associated with these illnesses.

National, state, and urban area vaccination coverage levels among children aged 19-35 months--United States, 1998.

Abstract: PROBLEM/CONDITION High vaccination levels in the population are necessary to decrease disease transmission and prevent disease; therefore, an important component of the U.S. vaccination program is the assessment of vaccination coverage. Current goals are for > or = 90% coverage with recommended vaccines during the first 2 years of life. REPORTING PERIOD January-December 1998. DESCRIPTION OF SYSTEMS The National Immunization Survey (NIS) is an ongoing, random-digit-dialed telephone survey that gathers vaccination coverage data for children aged 19-35 months in all 50 states and 28 urban areas. Vaccination coverage rates derived from NIS data are adjusted statistically for households with multiple telephone lines, household nonresponse, the proportion of households without telephones, and vaccination provider nonresponse. The results were also adjusted to match the known total population of children in each survey area. RESULTS On the basis of NIS data, national coverage was > or = 90% for three doses of poliovirus vaccine (Polio), three doses of Haemophilus influenzae type b vaccine (Hib), and one dose of measles-containing vaccine (MCV). Coverage was the highest ever reported for four doses of any diphtheria and tetanus toxoids and pertussis vaccine (DTP) (i.e., diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and tetanus toxoids [DT], or diphtheria and tetanus toxoids and acellular pertussis vaccine [DTaP]) (83.9%), three doses of hepatitis B vaccine (Hep B, 87.0%), and one dose of varicella vaccine (43.2%). The number of states achieving the > or = 90% goal was 47 for three doses of Hib, 40 for three doses of Polio, 40 for one dose of MCV, nine for three doses of Hep B, and seven for four doses of DTP. Proportionally fewer urban areas achieved the > or = 90% goal: 23 of 28 for three doses of Hib, 13 for three doses of Polio, 16 for one dose of MCV, five for three doses of Hep B, and one for four doses of DTP. No state or urban area has yet achieved the > or = 90% goal for varicella. INTERPRETATION Findings from the 1998 NIS indicate that national vaccination coverage levels for routinely recommended childhood vaccines are at the highest levels ever reported. However, substantial variation in coverage remains at the state and urban area levels. PUBLIC HEALTH ACTIONS The public health community and vaccination providers in areas with low coverage should intensify their efforts to implement recommended strategies for increasing vaccination coverage to ensure that children are equally well protected throughout the United States.

Surveillance for adverse events associated with anthrax vaccination - U.S. Department of Defense, 1998-2000.

Abstract: Concerns about the potential use of anthrax as a biologic weapon prompted the U.S. Department of Defense (DoD) to announce on December 15, 1997, anthrax vaccination of all U.S. military personnel. This effort is coordinated by the Anthrax Vaccine Immunization Program (AVIP). AVIP plans a phased vaccination process to achieve total force protection against anthrax by 2004. The current phase of implementation includes vaccination of all service members and mission-essential DoD civilian employees assigned or deployed to high-threat areas. On the basis of program monitoring, as of April 12, 2000, 425,976 service members had received 1,620,793 doses of anthrax vaccine adsorbed (AVA) (Bioport, Inc., Lansing, Michigan). Some service members have cited concerns about vaccine safety and efficacy in their decision to refuse vaccination, despite the possibility of administrative or disciplinary actions. To assess anthrax vaccination safety, DoD has conducted surveys of vaccinated personnel. This report describes three completed or ongoing surveys. The findings indicate that rates of local reactions were higher in women than men and that no patterns of unexpected local or systemic adverse events have been identified.