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A non-randomized prospective cohort study was conducted in 2022 to compare recovery rate and length of stay (LoS) for acutely malnourished children treated under South Sudan’s standard Community Management of Acute Malnutrition (CMAM) protocol and a COVID-modified protocol. Children aged 6–59 months received acute malnutrition (AM) treatment under the standard or modified protocol (mid-upper-arm circumference-only entry/exit criteria and simplified dosing). Primary (recovery rate and LoS) were compared for outpatient therapeutic (OTP) and therapeutic supplementary feeding programs (TSFP) using descriptive statistics and mixed-effects models. Children admitted to OTP under both protocols were similar in age and sex; children admitted to TSFP were significantly older under the modified protocol than the standard protocol. Shorter LoS and higher recovery rates were observed under the modified protocol for both OTP (recovery: 93.3% vs. 87.2%; LoS: 38.3 vs. 42.8 days) and TSFP (recovery: 79.8% vs. 72.7%; LoS: 54.0 vs. 61.9 days). After adjusting for site and child characteristics, neither differences in adjusted odds of recovery [OTP: 2.63; TSFP 1.80] nor LoS [OTP −10.0; TSFP −7.8] remained significant. Modified protocols for AM performed well. Adjusted models indicate similar treatment outcomes to the standard protocol. Adopting simplified protocols could be beneficial post-pandemic; however, recovery and relapse will need to be monitored.

We estimated US national prevalences of Internet use and looking up health information online among adults with epilepsy and those without, overall (age-standardized) and by three age groups (18–44, 45–59, and ≥ 60 years) using the 2013 National Health Interview Survey. Results showed that both overall and across all age groups, a significantly lower percentage of adults with active epilepsy reported using the Internet compared with that of adults without epilepsy. However, among Internet users, the percentage of looking up health information online did not differ by epilepsy status or age. Ensuring access to the Internet and encouraging use of quality, secure, and easy-to-access resources and e-tools might help adults with epilepsy to optimize their self-management and improve their quality of life. [ABSTRACT FROM AUTHOR]

During the 2007--08 influenza season, influenza activity peaked in mid-February in the United States and was associated with greater mortality and higher rates of hospitalization of children aged 0--4 years, compared with each of the previous three seasons. In the United States, influenza A (H1N1) was the predominant strain early in the season; influenza A (H3N2) viruses increased in circulation in January and predominated overall. While influenza A (H1N1), A (H3N2), and B viruses cocirculated worldwide, influenza A (H1N1) viruses were most commonly reported in Canada, Europe, and Africa, and influenza B viruses were predominant in most Asian countries. This report summarizes influenza activity in the United States and worldwide during the 2007--08 influenza season (September 30, 2007--May 17, 2008). [ABSTRACT FROM AUTHOR]

Rotavirus is the leading cause of severe acute gastroenteritis among infants and young children, accounting for an estimated 527,000 deaths among children aged <5 years worldwide in 2004. In the United States, rotavirus causes few deaths (20--60) each year, but remains a substantial cause of morbidity among children, resulting in approximately 55,000--70,000 hospitalizations, 205,000--272,000 emergency department (ED) visits, and 410,000 physician office visits. In the continental United States, rotavirus activity follows a distinct winter-spring seasonal pattern. In winter months, approximately 50% of hospitalizations and ED visits and 30% of outpatient visits for acute gastroenteritis among U.S. children aged <3 years are caused by rotavirus. To prevent rotavirus disease, in February 2006, a human-bovine rotavirus vaccine, RotaTeq(R) (Merck & Co., Inc., Whitehouse Station, New Jersey), was recommended for routine use among U.S. infants. To summarize rotavirus activity through May 3, during the current 2007--08 season, CDC analyzed data from the National Respiratory and Enteric Virus Surveillance System (NREVSS) and the New Vaccine Surveillance Network (NVSN). The results indicated that, when compared with the 15 previous seasons spanning 1991--2006, rotavirus activity during the current season appeared delayed in onset by 2--4 months and diminished in magnitude by >50%. Additional surveillance and epidemiologic studies are needed to confirm the impact of rotavirus vaccination on the 2007-08 season and to monitor the impact of the vaccine on the incidence and epidemiology of rotavirus during future seasons. [ABSTRACT FROM AUTHOR]

In 2008, CDC conducted an analysis of trends in diagnoses of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among men who have sex with men (MSM) in the 33 states that have had confidential, name-based HIV case reporting since at least 2001. This report summarizes the results of that analysis, which indicated that the number of HIV/AIDS diagnoses among MSM overall during 2001--2006 increased 8.6% (estimated annual percentage change [EAPC] = 1.5). During 2001--2006, an estimated 214,379 persons had HIV/AIDS diagnosed in the 33 states. Of these diagnoses, 46% were in MSM, and 4% were in MSM who engaged in illicit injection-drug use (IDU) (i.e., MSM and IDU). To reduce the impact of HIV/AIDS in the United States, HIV prevention services that aim to reduce the risk for acquiring and transmitting infection among MSM and link infected MSM to treatment must be expanded. [ABSTRACT FROM AUTHOR]

The New York City Department of Health and Mental Hygiene (NYC DOHMH) operates 10 sexually transmitted disease (STD) walk-in clinics offering various free services, including confidential or anonymous testing for human immunodeficiency virus (HIV). In January 2004, the STD clinics introduced on-site rapid HIV testing of finger-stick whole-blood specimens using the OraQuick(R) brand test (OraSure Technologies, Bethlehem, Pennsylvania). In March 2005, the clinics replaced finger-stick whole-blood testing with oral fluid testing with the OraQuick Advance Rapid HIV-1/2 Antibody Test. The clinics use Western blot confirmatory tests on serum to confirm all whole-blood or oral fluid reactive (i.e., preliminary positive) rapid tests. In late 2005, an unexpected increase in the number of false-positive oral fluid tests occurred, but the increase subsided after several months. In December 2005, while the cluster of false-positive oral fluid test results was being investigated, the NYC DOHMH Bureau of STD Control suspended oral fluid testing in the clinics for 3 weeks and replaced it with finger-stick whole-blood rapid testing, which produced no false-positive test results. On December 21, 2005, NYC DOHMH resumed oral fluid rapid testing but also introduced the use of immediate follow-up finger-stick whole-blood testing, using a second OraQuick test, after any reactive oral fluid test result. In late 2007, another larger increase in the incidence of false-positive oral fluid rapid test results was observed. The cause for the episodic increases in false-positive oral fluid tests has not yet been determined. NYC DOHMH has again suspended the use of oral fluid testing in STD clinics, and finger-stick whole-blood testing is the only rapid HIV test being used in this setting. These findings underscore the importance of confirming all reactive HIV tests, both from oral fluid and whole-blood specimens. In addition, the results suggest that the NYC DOHMH strategy of following up reactive oral fluid test results with an immediate finger-stick whole-blood test reduced the number of apparent false-positive oral fluid test results and might be a useful strategy in other settings and locations. [ABSTRACT FROM AUTHOR]

Laboratory confirmation of measles and rubella is an important component of disease surveillance in all settings. Because the use of clinical diagnosis for surveillance is unreliable, case-based laboratory confirmation of disease is critically important in settings with measles or rubella elimination goals. The World Health Organization (WHO) Measles and Rubella Laboratory Network (LabNet) was established in 2000 to provide a standardized testing and reporting structure and a comprehensive, external quality-assurance program. LabNet currently consists of 679 laboratories serving 166 countries. However, measles and rubella surveillance remains incomplete in certain areas because of difficulties with the collection and transport of serum specimens. Recently, LabNet evaluated two alternative sampling approaches to serum samples, the use of dried blood spots (DBS) and oral fluid (OF) samples. Both of these approaches have potential to be useful tools for measles and rubella control programs. In June 2007, WHO convened an ad hoc meeting in Geneva, Switzerland, to review available data and provide recommendations on use of DBS and OF samples for measles and rubella diagnostics. Attendees included LabNet staff members and scientists who had been conducting studies to evaluate use of these alternative diagnostic samples. The attendees concluded that 1) although serum-based diagnostics remain the 'gold standard,' the use of these two alternative sampling techniques would not adversely affect routine measles and rubella surveillance and might enhance surveillance; 2) regions in the elimination phase that already have established serum-based testing for rash illness surveillance would not likely benefit from converting to DBS or OF sampling methods, except in special circumstances; and 3) DBS or OF sampling are viable options for measles and rubella surveillance in all regions, especially where patients might resist venipuncture for blood collection, or where special challenges exist with transport or refrigeration of diagnostic samples. [ABSTRACT FROM AUTHOR]

Workers employed in outdoor occupations such as farming are exposed to hot and humid environments that put them at risk for heat-related illness or death. This report describes one such death and summarizes heat-related fatalities among crop production workers in the United States during 1992--2006. During this 15-year period, 423 workers in agricultural and nonagricultural industries were reported to have died from exposure to environmental heat; 68 (16%) of these workers were engaged in crop production or support activities for crop production. The heat-related average annual death rate for these crop workers was 0.39 per 100,000 workers, compared with 0.02 for all U.S. civilian workers. Data aggregated into 5-year periods indicated that heat-related death rates among crop workers might be increasing; however, trend analysis did not indicate a statistically significant increase. Prevention of heat-related deaths among crop workers requires educating employers and workers on the hazards of working in hot environments, including recognition of heat-related illness symptoms, and implementing appropriate heat stress management measures. [ABSTRACT FROM AUTHOR]

During 2006, approximately 6.8 million (9.3%) U.S. children and 16.1 million (7.3%) U.S. adults were reported to have asthma. Since 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of all persons with asthma because of the higher risk for medical complications from influenza for those persons. Influenza vaccination coverage of persons with asthma varies by age group and remains below Healthy People 2010 targets of 60% coverage of persons aged 18--64 years with high-risk conditions (14-29 c) and 90% of all persons aged > or =65 years (14-29 a). Influenza vaccination rates of children and older adults with asthma have not been well studied. Using 2006 National Health Interview Survey (NHIS) data, this report provides the first examination of influenza vaccination rates and related factors across a national sample of persons with asthma aged > or =2 years. The results indicated that 36.2% received influenza vaccination during the 2005--06 influenza season. Vaccination rates remained below target levels among all subgroups examined, including those reporting the greatest number of health-care visits in the past 12 months. The results of this study indicate that influenza vaccination coverage of all persons with asthma can be improved by increasing access to health care and using opportunities for vaccination during health-care visits. [ABSTRACT FROM AUTHOR]

Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal disease caused by infection with Naegleria fowleri, a thermophilic, free-living ameba found in freshwater environments. Infection results from water containing N. fowleri entering the nose, followed by migration of the amebae to the brain via the olfactory nerve. In 2007, six cases of PAM in the United States were reported to CDC; all six patients died. This report summarizes the investigations of the cases, which occurred in three southern tier states (Arizona, Florida, and Texas) during June-September and presents preliminary results from a review of PAM cases during 1937-2007. Because deaths from PAM often prompt heightened concern about the disease among the public, an updated and consistent approach to N. fowleri risk reduction messages, diagnosis and treatment, case reporting, and environmental sampling is needed. [ABSTRACT FROM AUTHOR]

Secondhand smoke (SHS) contains more than 50 carcinogens and causes heart disease and lung cancer in nonsmoking adults. Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from SHS exposure. Smoking restrictions limit smoking to certain areas within a venue; smoke-free policies prohibit smoking within the entire venue. A Healthy People 2010 objective (27-13) calls for establishing laws in all 50 states and the District of Columbia (DC) that make indoor public places and worksites completely smoke-free. To assess progress toward meeting this objective, CDC reviewed the status of state laws restricting smoking in effect as of December 31, 2007, updating a 2005 study that reported on such laws as of December 31, 2004. This report summarizes the changes in state smoking restrictions for private-sector worksites, restaurants, and bars that occurred from 2004 to 2007. The findings indicated a substantial increase in the number and restrictiveness of state laws regulating smoking in these three settings, providing nonsmokers with increased protection from the health risks posed by SHS. If current trends continue, achieving the national health objective by 2010 might be possible. [ABSTRACT FROM AUTHOR]

In 2006, approximately 70 million persons in the United States participated in recreational boating, and paddle sports vessels (i.e., canoes, kayaks, and inflatable rafts) made up the fastest-growing segment of the boating market. From 2005 to 2006, canoe sales in the United States increased by 23%, and kayak sales increased by 11%, while powerboat sales decreased by 5%. To analyze the trends and characteristics of deaths associated with paddle sports, the Maine Department of Health and Human Services examined data on fatalities that occurred during 2000-2007. The results of this analysis determined that paddle sports deaths were associated with inexperience, alcohol use, and not using a personal flotation device (PFD). To reduce the risk for paddle sports fatalities, boating organizations and water-sport enforcement agencies should encourage boater safety education, use of PFDs, and avoidance of alcohol before and during boating. [ABSTRACT FROM AUTHOR]

Infection with hepatitis C virus (HCV) is a leading cause of chronic liver disease in the United States. Chronic hepatitis B and C virus infections were added to the nationally notifiable diseases list in 2003. Approximately 3.2 million persons in the United States have chronic HCV infection. The most common risk factor for HCV infection is illicit drug use (specifically injection-drug use [IDU]), although approximately one third to one half of cases have no identified risk factor. Because approximately 80% of acute HCV infections are asymptomatic and no serologic markers for recent infection exist, distinguishing recent from distant infection based on serology alone is challenging and establishment of national HCV infection incidence is difficult. CDC provides funding to enhance surveillance for HCV infection and other forms of viral hepatitis in New York State (NYS) and seven other areas. One project of enhanced surveillance is to identify those HCV infections most likely to have been acquired recently. Since January 2006, NYSDOH has prioritized follow-up of positive laboratory markers for HCV infection among persons aged <30 years because they are more likely to be newly infected than older persons. In February 2007, NYSDOH detected a cluster of HCV infections among persons in this age group by using the prioritized algorithm. This report describes the subsequent investigation by NYSDOH and the Erie County Department of Health (ECDOH), which identified a group of patients with histories of IDU who were linked through a single high school that all the patients had attended at some time. The findings demonstrate how targeted enhanced surveillance can effectively detect clusters and outbreaks and guide appropriate interventions. [ABSTRACT FROM AUTHOR]

During January 1, 2006-December 31, 2007, CDC collaborated with public health officials in Pennsylvania, other states, and the Food and Drug Administration (FDA) to investigate a prolonged multistate outbreak of Salmonella enterica serotype Schwarzengrund infections in humans. A total of 70 cases of S. Schwarzengrund infection with the outbreak strain (XbaI pulsed-field gel electrophoresis [PFGE] pattern JM6X01.0015) were identified in 19 states, mostly in the northeastern United States. This report describes the outbreak investigation, which identified the source of infection as dry dog food produced at a manufacturing plant in Pennsylvania. This investigation is the first to identify contaminated dry dog food as a source of human Salmonella infections. After handling pet foods, pet owners should wash their hands immediately, and infants should be kept away from pet feeding areas. [ABSTRACT FROM AUTHOR]

Although the number of deaths from stroke has declined substantially since the 1960s, in 2004, stroke remained the third leading cause of death in the United States, after heart disease and cancer. Approximately 54% of U.S. stroke deaths in 2004 occurred outside of a hospital. Intravenous administration of tissue plasminogen activator has clinical benefits for patients with acute ischemic stroke; however, treatment should begin within 3 hours of symptom onset for these benefits to be realized. For hemorrhagic stroke, immediate surgery (e.g., aneurysm repair) is crucial to prevent rebleeding that results in serious impairment or death in 40% to 60% of cases. A revised objective of Healthy People 2010 is to increase to 83% the proportion of persons who are aware of the warning symptoms of stroke and the need to telephone 9-1-1 immediately if someone appears to be having a stroke (objective no. 12-8). To assess public awareness of stroke warning symptoms and the importance of seeking emergency care, CDC analyzed data from an optional module of the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey that was used in 13 states and the District of Columbia (DC). The results indicated that the percentages of respondents who recognized all five correct symptoms, identified an incorrect symptom, and recognized the need to telephone 9-1-1 was low; the percentage who met all three measures was 16.4%. In addition, disparities were observed by race/ethnicity, sex, and education level. Public health agencies, clinicians, and educators should continue to stress the importance of learning to recognize stroke symptoms and the need to telephone 9-1-1 when someone appears to be having a stroke. [ABSTRACT FROM AUTHOR]

During March 2006-April 2007, an outbreak of Salmonella enterica serotype Newport infections occurred predominantly among Hispanics in northeastern Illinois. Samples from 85 patients, one sample of Mexican-style aged cheese (cotija) from a local Hispanic grocery store (grocery store A), and milk from a bulk tank on a local dairy farm tested positive for S. Newport and had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. This report summarizes the investigation into S. Newport infections associated with this outbreak. The findings emphasize the need for regulatory authorities to ensure that dairy products, including Mexican-style cheese, are manufactured and distributed by inspected sources and highlight the need for culturally targeted education of consumers and grocery-store operators regarding risks associated with consuming unpasteurized dairy products. [ABSTRACT FROM AUTHOR]

During clinical trials, the efficacy of vaccination with inactivated influenza vaccines for the prevention of serologically confirmed influenza infection has been estimated as high as 70%-90% among healthier adults. However, the effectiveness of annual influenza vaccination typically is lower during those influenza seasons when a suboptimal match between the vaccine strains and circulating influenza strains is observed. For example, in a 4-year randomized study of influenza vaccine among healthy persons aged 1-65 years, the predominant strain was drifted from the vaccine strain in 2 of the 4 years. Inactivated vaccine effectiveness (VE) against culture-confirmed influenza ranged from 71% to 79% when the vaccine and circulating strains were suboptimally matched to 74% to 79% when the matches were well matched. In contrast, a 2-year study of inactivated influenza vaccine among healthy adults aged 18-64 years found no measurable VE during a year when a poorly matched strain circulated, but found VE of 86% against laboratory-confirmed influenza during the following year when the vaccine and circulating strains were well matched. Although laboratory data on the antigenic characteristics of circulating influenza viruses compared with vaccine strains are available during influenza seasons, estimates of VE usually have not been made until months after the conclusion of the season. This report summarizes interim results of a 2008 case-control study to estimate the effectiveness of trivalent inactivated influenza vaccine for prevention of medically attended, laboratory-confirmed influenza during the 2007-08 influenza season, when most circulating influenza A (H3N2) and B viruses were suboptimally matched to the vaccine strains. Despite the suboptimal match between two of three vaccine strains and circulating influenza strains, overall VE in the study population during January 21-February 8, 2008, was 44%. These findings demonstrate that, in any season, assessment of the clinical effectiveness of influenza vaccines cannot be determined solely by laboratory evaluation of the degree of antigenic match between vaccine and circulation strains. [ABSTRACT FROM AUTHOR]

Approximately 28,000 organ transplants were performed in the United States in 2007. When infections are transmitted from donors, the implications can be serious for multiple recipients. Tuberculosis (TB), a known infectious disease complication associated with organ transplantation, occurs in an estimated 0.35%-6.5% of organ recipients in the United States and Europe posttransplantation. In 2007, the Oklahoma State Department of Health identified Mycobacterium tuberculosis in an organ donor 3 weeks after the donor's death. This report summarizes results of the subsequent investigation, which determined that disseminated TB occurred in two of three transplant recipients from this donor, and one recipient died. Genotypes of the donor and recipient TB isolates were identical, consistent with transmission of TB by organ transplantation. To reduce the risk for TB transmission associated with organ transplantation, organ recovery personnel should consider risk factors for TB when assessing all potential donors. In addition, clinicians should recognize that transplant recipients with TB might have unusual signs or symptoms. When transmission is suspected, investigation of potential donor-transmitted TB requires rapid communication among physicians, transplant centers, organ procurement organizations (OPOs), and public health authorities. [ABSTRACT FROM AUTHOR]

On April 26, 2007, a patient from Alberta, Canada, died after 9 weeks in an intensive care unit (ICU) from encephalitis caused by a rabies virus variant associated with silver-haired bats. This report summarizes the clinical course of disease in that patient, who was treated using the Milwaukee Protocol, an experimental treatment protocol similar to one used for the rabies survivor described in 2005. This report also describes the subsequent epidemiologic investigations by three regional public health departments in Alberta. Rabies continues to be a cause of human death in the developed and developing world. The findings in this report underscore the need for continued public education that promotes rabies prevention and postexposure prophylaxis while emphasizing the importance of bat exposure in rabies transmission. [ABSTRACT FROM AUTHOR]

Measles, once a common childhood disease in the United States, can result in severe complications, including encephalitis, pneumonia, and death. Because of successful implementation of measles vaccination programs, endemic measles transmission has been eliminated in the United States and the rest of the Americas. However, measles continues to occur in other regions of the world, including Europe. In January 2008, measles was identified in an unvaccinated boy from San Diego, California, who had recently traveled to Europe with his family. After his case was confirmed, an outbreak investigation and response were initiated by local and state health departments in coordination with CDC, using standard measles surveillance case definitions and classifications. This report summarizes the preliminary results of that investigation, which has identified 11 additional cases of measles in unvaccinated children in San Diego that are linked epidemiologically to the index case and include two generations of secondary transmission. Recommendations for preventing further measles transmission from importations in this and other U.S. settings include reminding health-care providers to 1) consider a diagnosis of measles in ill persons who have traveled overseas, 2) use appropriate infection-control practices to prevent transmission in health-care settings, and 3) maintain high coverage with measles, mumps, and rubella (MMR) vaccine among children. [ABSTRACT FROM AUTHOR]

The 'choking game' is defined as self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. Participants in this activity typically are youths. Serious neurologic injury or death can result if strangulation is prolonged. In recent years, news media reports have described numerous deaths among youths attributed to the choking game. Because no traditional public health dataset collects mortality data on this practice, CDC used news media reports to estimate the incidence of deaths from the choking game. This report describes the results of that analysis, which identified 82 probable choking-game deaths among youths aged 6-19 years, during 1995-2007. Seventy-one (86.6%) of the decedents were male, and the mean age was 13.3 years. Parents, educators, and health-care providers should become familiar with warning signs that youths are playing the choking game. [ABSTRACT FROM AUTHOR]

In late April 2006, the Maryland Department of Health and Mental Hygiene (DHMH) was notified by a local health department of a case of pulmonary tuberculosis (TB) in a patient with cavitary lung lesions and numerous acid-fast bacilli (AFB) observed on a sputum smear. The patient worked for an office furniture installation company at multiple sites in Maryland, the District of Columbia (DC), and Virginia. An investigation was conducted to 1) determine the extent of TB transmission, including identifying and screening the exposed cohort of contacts, and 2) provide treatment, if indicated, to contacts with latent TB infection (LTBI) or TB disease. This report describes the multijurisdictional contact investigation and summarizes its results. The findings underscore the importance of prompt diagnosis of TB, the value of interjurisdictional cooperation during large contact investigations, and the effectiveness of workplace-based methods for rapidly identifying and screening contacts. [ABSTRACT FROM AUTHOR]

Neural tube defects (NTDs) are serious birth defects of the brain (anencephaly) and spine (spina bifida) that affect approximately 3,000 pregnancies each year in the United States. In 1992, the U.S. Public Health Service recommended that all women of childbearing age in the United States capable of becoming pregnant consume 400 microg of folic acid daily to reduce their risk for having a pregnancy affected by NTDs. To assess awareness, knowledge, and behavior related to folic acid among women of childbearing age (aged 18-45 years), CDC analyzed the results of a national survey conducted annually by the Gallup Organization during the period 2003-2007. This report summarizes the results of that analysis, which indicated that, among all women of childbearing age, those aged 18-24 years had the least awareness regarding folic acid consumption (61%), the least knowledge regarding when folic acid should be taken (6%), and the lowest reported daily use of supplements containing folic acid (30%). Because women in this age group account for nearly one third of all births in the United States, promotion of folic acid consumption should be targeted to this population. [ABSTRACT FROM AUTHOR]

Birth defects are one of the leading causes of infant mortality in both the mainland United States and Puerto Rico. Neural tube defects (NTDs) are serious birth defects of the spine and brain; two of the most common NTDs are spina bifida and anencephaly. In the United States, NTD prevalence is higher among Hispanic women than among non-Hispanic white or non-Hispanic black women. In Puerto Rico, where most residents are Hispanic, the prevalence of NTDs (8.68 per 10,000 live births) is higher than in the mainland United States (5.59). Consumption of folic acid before and during early pregnancy can prevent NTDs. To assess trends in NTD prevalence and prevalence of knowledge and consumption of folic acid supplements in Puerto Rico, data were analyzed from the Birth Defects Surveillance System (BDSS) for 1996-2005 and the Behavioral Risk Factor Surveillance System (BRFSS) for 1997-2006. This report describes the results of those analyses, which indicated that prevalence of folic acid knowledge and consumption among women of childbearing age increased from 1997 to 2003 but decreased from 2003 to 2006. During similar periods, NTD prevalence declined from 1996 to 2003 but did not change significantly from 2003 to 2005. To resume the decline in prevalence of NTDs, additional measures might be needed to increase folic acid supplement use among Puerto Rican women of childbearing age. [ABSTRACT FROM AUTHOR]

Major structural or genetic birth defects affect approximately 3% of births in the United States, are a major contributor to infant mortality, and result in billions of dollars in costs for care. Although the causes of most major birth defects are unknown, concerns have been raised that certain factors, such as an increase in the prevalence of diabetes among women, might result in increased prevalence of birth defects over time. This report updates previously published data from the Metropolitan Atlanta Congenital Defects Program (MACDP), the oldest population-based birth defects surveillance system in the United States with active case ascertainment. For the period 1978-2005, CDC assessed the overall prevalence of major birth defects and their frequency relative to selected maternal and infant characteristics. The MACDP results indicated that the prevalence of major birth defects in metropolitan Atlanta, Georgia, remained stable during 1978-2005 but varied by maternal age and race/ethnicity, birthweight, and gestational age. Tracking the overall prevalence of major birth defects can identify subgroups that are affected disproportionately; additional measures focused on these subgroups might improve preconception care and care during pregnancy to prevent birth defects. [ABSTRACT FROM AUTHOR]

On February 8, 2007, the District of Columbia Department of Health (DCDOH) was notified of an outbreak of acute gastroenteritis in an elementary school (prekindergarten through sixth grade). The school nurse reported that 27 students and two staff members had become ill during February 4--8 with nausea, vomiting, and diarrhea; because symptoms lasted <48 hours, a viral etiology was suspected. DCDOH recommended two preinvestigation interventions, which were implemented the same evening (February 8): 1) more thorough handwashing and 2) bleach cleaning of all shared environmental surfaces with a diluted (1:50 concentration) household bleach solution. This report summarizes the subsequent investigation of the outbreak, which suggested that noncleaned computer equipment (i.e., keyboards and mice) and person-to-person contact resulted in illness. To decrease disease transmission during gastroenteritis outbreaks, public health officials should emphasize good handwashing practices, exclusion of ill persons, and thorough environmental disinfection, including fomites that are shared but not commonly cleaned. [ABSTRACT FROM AUTHOR]

On July 24, 2007, the South Carolina Department of Health and Environmental Control (SCDHEC) was notified by the North Carolina Division of Public Health (NCDPH) of a stray, rabid kitten that had been handled by players on several girls' softball teams during a tournament in Spartanburg County, South Carolina. This report summarizes the public health response to exposure to the rabid kitten and highlights the importance of multistate collaboration in a rabid animal investigation. [ABSTRACT FROM AUTHOR]

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend that women who give birth have a postpartum care visit (PPCV) 4-6 weeks after delivery. PPCVs provide important opportunities to assess the physical and psychosocial well-being of the mother, counsel her on infant care and family planning, and detect and give appropriate referrals for preexisting or developing chronic conditions such as diabetes, hypertension, or obesity. To estimate the prevalence of PPCVs among U.S. women who deliver live infants, CDC analyzed population-based 2004 data (the most recent data available) from 12 areas (11 states and New York City) participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). This report summarizes the results of that analysis, which indicated that although the overall prevalence of PPCVs among U.S. women who deliver is high (89%), rates are significantly lower in certain population subgroups (e.g., 71% among women with < or =8 years of education and 66% among women who had not received prenatal care). To help reach all population subgroups, the importance of the PPCV should be communicated to all women at the time of discharge from the hospital after delivery. [ABSTRACT FROM AUTHOR]

Syringe exchange programs (SEPs) provide free sterile syringes in exchange for used syringes to reduce transmission of bloodborne pathogens among injection-drug users (IDUs). SEPs in the United States began as a way to prevent the spread of human immunodeficiency virus (HIV) and other bloodborne infections such as hepatitis B and hepatitis C. The National Institute on Drug Abuse recommends that persons who continue to inject drugs use a new, sterile syringe for each injection. Monitoring syringe exchange activity is an important part of assessing HIV prevention measures in the United States. As of November 2007, a total of 185 SEPs were operating in 36 states, the District of Columbia (DC), and Puerto Rico (North American Syringe Exchange Network [NASEN], unpublished data, 2007). This report summarizes a survey of SEP activities in the United States during 2005 and compares the findings with previous SEP surveys (Beth Israel Medical Center [BIMC], unpublished data, 2000 and 2004). The findings indicated an increase in overall funding for SEPs, including an increase in public funding, and a stabilization in both the number of SEPs operating and the number of syringes exchanged since 2004. This report also documents an expansion of services offered by SEPs, a trend that resulted from an increase in state and local funding. These expanded services are helping protect IDUs and their communities from the spread of bloodborne pathogens and are providing access to health services for a population at high risk. Monitoring of syringe exchange activity should continue. [ABSTRACT FROM AUTHOR]

One of the national health objectives for 2010 is to reduce the prevalence of cigarette smoking among adults to > or =12% (objective 7-1a). To assess progress toward achieving this objective, CDC analyzed data from the 2006 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that in 2006, approximately 20.8% of U.S. adults were current cigarette smokers. This prevalence had not changed significantly since 2004, suggesting a stall in the previous 7-year (1997-2004) decline in cigarette smoking among adults in the United States. In addition, the findings indicated that persons with a diagnosis of a smoking-related chronic disease have a significantly higher prevalence of being a current smoker than persons with other chronic diseases or persons with no chronic disease. To reduce smoking prevalence further in the United States, comprehensive, evidence-based approaches for preventing smoking initiation and increasing cessation, including clinical interventions for populations at high risk, need to be fully implemented. [ABSTRACT FROM AUTHOR]

Blood-glucose control is critical for managing diabetes and preventing diabetes-related complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. In addition to recommending that patients with diabetes have a glycated hemoglobin (HbA1c) measurement at least two times a year, the American Diabetes Association recommends self-monitoring of blood glucose (SMBG) as an integral part of diabetes management for patients who are treated with insulin and as a useful component for achieving glycemic goals for patients who use oral medications or medical nutrition therapy. One of the Healthy People 2010 national objectives is to increase to 61% the proportion of persons with diabetes who perform SMBG at least once a day (objective 5-17). To estimate the rates of SMBG and to track the progress of states during 1997-2006, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for that period. This report summarizes the findings of that analysis, which indicated that the proportion of adults with diabetes who check their blood glucose at least once a day increased at the national level, and 25 of the 38 states examined had statistically significant rate increases from 1997 to 2006. In 2006, the daily SMBG rate was 63.4% among all adults with diabetes and 86.7% among those treated with insulin. Collaborations to ensure adequate health insurance coverage, diabetes education and counseling to encourage more intensive medical care and self-management practices, and continued surveillance measures to track changes in SMBG rates are needed to improve and monitor SMBG trends. [ABSTRACT FROM AUTHOR]