Perchlorate exposure of the US Population, 2001-2002

Perchlorate is commonly found in the environment and can impair thyroid function at pharmacological doses. As a result of the potential for widespread human exposure to this biologically active chemical, we assessed perchlorate exposure in a nationally representative population of 2,820 US residents, ages 6 years and older, during 2001 and 2002 as part of the National Health and Nutrition Examination Survey (NHANES). We found detectable levels of perchlorate (>0.05 microg/l) in all 2,820 urine samples tested, indicating widespread human exposure to perchlorate. Urinary perchlorate levels were distributed in a log normal fashion with a median of 3.6 microg/l (3.38 microg/g creatinine) and a 95th percentile of 14 microg/l (12.7 microg/g creatinine). When geometric means of urinary perchlorate levels were adjusted for age, fasting, sex and race-ethnicity, we found significantly higher levels of urinary perchlorate in children compared with adolescents and adults. We estimated total daily perchlorate dose for each adult (ages 20 years and older), based on urinary perchlorate, urinary creatinine concentration and physiological parameters predictive of creatinine excretion rate. The 95th percentile of the distribution of estimated daily perchlorate doses in the adult population was 0.234 microg/kg-day [CI 0.202-0.268 microg/kg-day] and is below the EPA reference dose (0.7 microg/kg-day), a dose estimated to be without appreciable risk of adverse effects during a lifetime of exposure. These data provide the first population-based assessment of the magnitude and prevalence of perchlorate exposure in the US.     

Sources of food group intakes among the US population, 2001-2002

BACKGROUND: Food guides are typically built around a system of food groups. Accordingly, the US Department of Agriculture's MyPyramid includes both food groups and subgroups, as well as an allowance for discretionary calories, in its guidance. OBJECTIVE: To identify the major dietary contributors to food group intake in the US population. METHODS: This cross-sectional study used 2001-2002 National Health and Nutrition Examination Survey data to determine weighted population proportions for the contribution of each subgroup to its MyPyramid food group (ie, proportion), and the contribution of specific foods to the subgroups oils, solid fats, and added sugars (ie, major contributors). Food codes associated with each food were sorted into 96 categories, termed specific foods, and were linked to the MyPyramid Equivalents Database to obtain food group equivalents. RESULTS: In regard to proportion, dark green vegetables (6%), orange vegetables (5%), and legumes (6%) fell well short of recommended levels. Intake of whole grains (10% of total) was far below the recommendation that at least half of all grains be whole. In regard to major contributors, top sources of oils were potato chips, salad dressing, and nuts/seeds; major contributors of solid fats were grain-based desserts, cheese, and sausages. Sweetened carbonated beverages provided 37% of added sugars. CONCLUSIONS: Americans do not, in general, consume the most nutrient-dense forms of basic food groups, instead consuming foods that are high in solid fats and added sugars. The main culprits-the foods that contribute most to discrepancies between recommendations and actual intake-are sweetened carbonated beverages and other sweetened beverages, grain-based desserts, nonskim dairy products, and fatty meats.     

Surveillance of influenza in Apulia, Italy, 1999-2000, 2000-2001, 2001-2002, and 2002-2003 seasons

BACKGROUND: The objective of this study was to evaluate, within the Italian National Influenza Epidemiological and Virological Surveillance, the rate of vaccination coverage, the incidence of Influenza Like-Illness (ILI), the incidence of Acute Respiratory Illness (ARI), and to identify the virus strains circulating in Apulia from 1999 to 2003. METHODS: Vaccination coverage rates were calculated based on the number of doses administered to individuals > 65 years of age. Every week, sentinel physicians reported ILI and ARI cases having occurred among their patients. Voluntary general practitioners (GPs) and paediatricians (Ps) collected oropharyngeal swab samples from patients suspected with ILI. Influenza viruses were isolated and identified by cell culture (MDCK cells) and RT-PCR. Virological surveillance was carried out by the ISS, in collaboration with a network of peripheral laboratories. RESULTS: In Apulia, vaccination coverage progressively increased to 68.6% during the 2002-2003 season. The analysis of ILI cases showed higher incidence rates during the 1999-2000 and 2002-2003 seasons. ARI rates appeared to have a more constant trend. ILI and ARI incidence rates were higher in the 0-14 year age group. CONCLUSION: The increase in vaccination coverage rates and implementation of the network of clinical, and epidemiological and virological surveillance are fundamental for the control and prevention of influenza.     

Lyme disease--United States, 2001-2002

Lyme disease (LD) is caused by the spirochete Borrelia burgdorferi and is transmitted through the bite of Ixodes spp. ticks. CDC began LD surveillance in 1982, and the Council of State and Territorial Epidemiologists designated LD a nationally notifiable disease in 1991. This report summarizes the analysis of 40,792 cases of LD reported to CDC during 2001-2002. The results of that analysis indicate that annual LD incidence increased 40% during this period. The continued emergence of LD underscores the need for persons in areas where LD is endemic to reduce their risk for infection through integrated pest management, landscaping practices, repellent use, and prompt removal of ticks.     

Dengue fever, Hawaii, 2001-2002

Autochthonous dengue infections were last reported in Hawaii in 1944. In September 2001, the Hawaii Department of Health was notified of an unusual febrile illness in a resident with no travel history; dengue fever was confirmed. During the investigation, 1,644 persons with locally acquired denguelike illness were evaluated, and 122 (7%) laboratory-positive dengue infections were identified; dengue virus serotype 1 was isolated from 15 patients. No cases of dengue hemorrhagic fever or shock syndrome were reported. In 3 instances autochthonous infections were linked to a person who reported denguelike illness after travel to French Polynesia. Phylogenetic analyses showed the Hawaiian isolates were closely associated with contemporaneous isolates from Tahiti. Aedes albopictus was present in all communities surveyed on Oahu, Maui, Molokai, and Kauai; no Ae. aegypti were found. This outbreak underscores the importance of maintaining surveillance and control of potential disease vectors even in the absence of an imminent disease threat.     

Increase in imported dengue, Germany, 2001-2002

Dengue fever is a reportable disease in Germany. Surveillance data from 2001 and 2002 were analyzed and compared to travel patterns. Imported dengue fever increased strongly in this time. Most infections were acquired in Southeast Asia, specifically Thailand. The 2002 epidemic in Brazil was also reflected in these data.     

Outbreak of measles--Venezuela and Colombia, 2001-2002

Substantial progress has been made toward interrupting indigenous measles transmission in the Region of the Americas. In 2001, the number of confirmed measles cases in the region reached a record low of 537 cases, a 99% decrease since 1990. During 2001, the Dominican Republic and Haiti interrupted indigenous measles transmission successfully, ending known indigenous transmission of the D6 measles virus genotype. This genotype, which had circulated widely in the Region of the Americas since 1995, caused nationwide outbreaks in Argentina, Bolivia, Brazil, the Dominican Republic, and Haiti during 1997-2001. In August 2001, a measles outbreak introduced by a traveler returning from Europe occurred in Venezuela and was exported to Colombia in 2002. This report describes the epidemiology of the outbreaks and control measures implemented by the ministries of health of Venezuela and Colombia.     

Infant botulism--New York City, 2001-2002

Infant botulism results from germination of swallowed spores of botulinum toxin-producing clostridia that colonize the large intestine temporarily. Four cases of type B infant botulism in one New York City (NYC) borough were diagnosed within a 12-month period during 2001-2002. All four patients resided in Staten Island (2000 population: 443,728). The annual incidence of infant botulism in the United States is two cases per 100,000 live births; incidence in NYC is four cases per 100,000 live births. Staten Island recorded 5,899 live births in 2000; incidence of infant botulism during this 12-month period was 68 cases per 100,000 live births. This report summarizes the investigation of these four cases; as expected with infant botulism, a common source of exposure was not identified. All four patients recovered after treatment and were discharged from local hospitals. State and local health departments should be notified promptly when infant botulism is suspected to arrange diagnostic testing.     

Manufacturer's recall of rapid assay kits based on false positive Cryptosporidium antigen tests--Wisconsin, 2001-2002

The Wisconsin Division of Public Health and the Wisconsin State Laboratory of Hygiene (WSLH) reported that a recent cluster of cryptosporidiosis cases in a three-county area in southeastern Wisconsin was the result of false-positive tests. During December 1, 2001-February 1, 2002, approximately 30 cases of cryptosporidiosis were diagnosed at a laboratory in southeastern Wisconsin using the Becton, Dickinson, and Company (Franklin Lakes, New Jersey) ColorPAC Cryptosporidium/Giardia rapid assay (lot number 219370, expiration date 2002-06-05). Seventeen stool specimens, which were collected from 11 patients and tested positive by the rapid assay, were re-evaluated at WSLH. Six of these stool specimens were in EcoFix (Meridian Bioscience Inc., Cincinnati, Ohio), eight were in Cary-Blair transport media, and three were formalin fixed. All 17 specimens tested negative for Cryptosporidium at WSLH using the hot safranin stain and MeriFluor (Meridian Bioscience Inc., Cincinnati, Ohio) Cryptosporidium/Giardia direct fluorescent antibody kit with concentrated specimens.     

Total, free, and percent free prostate-specific antigen levels among U.S. men, 2001-04

OBJECTIVE: Screening for prostate cancer using prostate-specific antigen (PSA) tests is common but remains controversial. Total PSA using thresholds of 4.0 and 2.5 ng/mL has been used for screening men. In addition, the percent free PSA (free PSA/total PSA x 100%) using thresholds of less than 25% and 15% have been proposed for use in screening for prostate cancer in conjunction with the total PSA. The distributions of total PSA, free PSA, and percent free PSA, which vary with age and race-ethnicity among American men, would help determine the burden of screening using different thresholds of PSA tests. METHODS: PSA tests were performed on serum samples from men age 40 years and older (n = 2,546) who participated in the 2001-04 National Health and Nutrition Examination Survey (NHANES). Total, free and percent free PSA were estimated for Mexican American, non-Hispanic white, and non-Hispanic black men. RESULTS: About 6.2%, (95% confidence interval, 95% CI: 5.2-7.2%), corresponding to an estimated 3.6 million (95% CI: 3.0-4.2 million) men 40 years of age and older, had a total PSA of greater than or equal to 4.0 ng/mL. Approximately 3.6% (95% CI: 1.8-6.2%) of Mexican American men, 6.2% (95% CI: 5.1-7.6%) of non-Hispanic white men, and 7.8% (95% CI: 5.2-11.1 ) of non-Hispanic black men had total PSA of 4.0 ng/mL or more. Approximately 13.1 (95% CI: 11.7-14.5%) of men 40 years of age and older had total PSA greater than or equal to 2.5 ng/mL. For men with total PSA less than 2.5 ng/mL, 23.1% (95% CI: 21.0-25.3%) had a percent free PSA between 15% and 25%, and 5.0% had free PSA (95% CI: 3.9-6.4%) less than or equal to 15%. CONCLUSIONS: The effect of lowering the total PSA thresholds increases the number of U.S. men who would be referred for screening for prostate cancer. Total and free PSA increased with age in Mexican American, non-Hispanic white, and non-Hispanic black men. Information about the distribution of total, free, and percent free PSA will help guide public health policy in screening for prostate cancer.     

Human and canine pulmonary blastomycosis, North Carolina, 2001-2002

We investigated a cluster of blastomycosis in 8 humans and 4 dogs in a rural North Carolina community. Delayed diagnosis, difficulty isolating Blastomyces dermatitidis in nature, and lack of a sensitive and specific test to assess exposure make outbreaks of this disease difficult to study.     

广州市2001～2002年化妆品卫生检测结果分析

广州市化妆品生产企业众多,尤其近几年化妆品生产发展较快,规模更大,品种更多。为了解广州市化妆品卫生质量状况,更好地进行卫生监督管理,现将广州市2001～2002年生产的化妆品卫生检测结果分析如下。     

广东省2001～2002年HIV监测结果分析

目的 分析广东省各监测人群艾滋病病毒／艾滋病(HIV／AIDS)的感染状况及相关行为情况,掌握广东省HIV／AIDS的流行趋势。方法 分析广东省2001～2002年的HIV／AIDS常规、哨点、行为监测资料。结果 2001年和2002年广东省分别报告HIV／A／DS1174和1072例,感染者主要分布在珠江三角洲地区。2002年感染者中静脉吸毒占92．21％,性途径占6．53％;感染者中男性占86．11％,女性占13．89％,与2001年相比,女性感染者的比例增加。2002年哨点监测显示,吸毒人群中HIV阳性率为3．03％,暗娼阳性率为1．22％,在孕产妇和一般人群中开始检出HIV阳性者;静脉吸毒者中共用针具率为50．83％,安全套使用率为10．54％;暗娼中25．28％的人曾吸毒,安全套使用率仅为30,92％。结论 广东省静脉注射者中共用注射器情况仍然严重．性乱人群中安全套的使用率仍然偏低,HIV／AIDS开始向一般人群扩散,控制艾滋病流行的关键是减少和消除高危人群中HIV流行潜在的危险因素,提高一般人群预防艾滋病的知识和技能。     

Nonfatal motor-vehicle animal crash-related injuries--United States, 2001-2002

In 2000, an estimated 6.1 million light-vehicle (e.g., passenger cars, sport utility vehicles, vans, and pickup trucks) crashes on U.S. roadways were reported to police. Of these reported crashes, 247,000 (4.0%) involved incidents in which the motor vehicle (MV) directly hit an animal on the roadway. Each year, an estimated 200 human deaths result from crashes involving animals (i.e., deaths from a direct MV animal collision or from a crash in which a driver tried to avoid an animal and ran off the roadway). To characterize nonfatal injuries from these incidents, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, during 2001-2002, an estimated 26,647 MV occupants per year were involved in crashes from encounters with animals (predominantly deer) in a roadway and treated for nonfatal injuries in U.S. hospital emergency departments (EDs). Cost-effective measures targeting both drivers (e.g., speed reduction and early warnings) and animals (e.g., fencing and underpasses) are needed to reduce injuries associated with MV collisions involving animals.     

Nonfatal and fatal drownings in recreational water settings--United States, 2001-2002

Drowning is the seventh leading cause of unintentional injury deaths for all ages and the second leading cause of all injury deaths in children aged 1-14 years. Many of these injuries occur in recreational water settings, including pools, spas/hot tubs, and natural water settings (e.g., lakes, rivers, or oceans). To examine the incidence and characteristics of nonfatal and fatal unintentional drownings in recreational water settings, CDC analyzed 2001-2002 data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) and National Vital Statistics System (NVSS) death certificate data from 2001. This report summarizes that analysis, which indicated that, during 2001-2002, an estimated 4,174 persons on average per year were treated in U.S. hospital emergency departments (EDs) for nonfatal unintentional drowning injuries in recreational water settings. Approximately 53% of persons required hospitalization or transfer for more specialized care. During 2001, a total of 3,372 persons suffered fatal unintentional drownings in recreational settings. Nonfatal and fatal injury rates were highest for children aged < or =4 years and for males of all ages. To reduce the number of drownings, environmental protections (e.g., isolation pool-fences and lifeguards) should be adopted; alcohol use should be avoided while swimming, boating, or water skiing or while supervising children; and all participants, caregivers, and supervisors should be knowledgeable regarding water-safety skills and be trained in cardiopulmonary resuscitation (CPR).     

Entry of US medical school graduates into family practice residencies: 2001-2002 and 3-year summary

This is the 21st report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 10.9% of the 15,900 graduates of US medical schools between July 2000 and June 2001 were first-year family practice residents in 2001, compared with 12.8% in 2000 and 13.4% in 1999. Medical school graduates from publicly funded medical schools were more likely to be first-year family practice residents in October 2001 than were residents from privately funded schools, 12.7% compared with 8.4%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 2001 at 15.2%; the Middle Atlantic and New England regions reported the lowest percentages at 8.0% and 7.2%, respectively. Nearly half of the medical school graduates (48.0%) entering a family practice residency program as first-year residents in October 2001 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Councilfor Graduate Medical Education-accreditedfamily practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Antimicrobial susceptibility, serotype and genotype distribution of meningococci in Portugal, 2001-2002

One hundred and eighteen Neisseria meningitidis isolates were recovered from patients with invasive meningococcal disease in Portugal, over one year. Our study was undertaken to evaluate antimicrobial susceptibility, serogroup, serotype and genotype of isolates. One quarter (24.6%) of the isolates showed moderate resistance to penicillin and 47.4% were resistant to sulphadiazine. The two most common serosubtypes were C:2b:P1.5,2 (31.3%) and B:4:P1.15 (3.4%). Half (53.6%) of the isolates with moderate resistance to penicillin were phenotype C:2b:P1.5,2 (n=14), C:2b:P1.2 (n=1) or C:2b:NST (n=1); Pulsed-field gel electrophoresis (PFGE) showed that all these isolates were genetically related. Multilocus sequence typing (MLST) analysis of representative clones from each PFGE pattern showed the predominance of the ST-8 complex/cluster A4 among N. meningitidis with moderate resistance to penicillin. This clonal complex has been principally found in Southern Europe. The apparent emergence and dissemination of the hypervirulent ST-8 complex/cluster A4 among serogroup C strains increases the need for a continued surveillance of antimicrobial susceptibility of meningococci and of genotypic markers in Portugal.     

无锡市2001年～2002年度流感监测分析

目的：监测分析我市流行性感冒的流行和流感病毒变异情况．为流感防治对策提供理论依据。方法：①疫情监测,设立哨点医院．在内科、儿科门诊监测流感样病例和肺炎病例;②病原学监测,用鸡胚双腔对监测标本做病毒分离,用微量血凝抑制试验(HI)进行型别鉴定;③血清学监测,采集不同年龄组的自然人群血清．检测甲1型、甲3型和乙型流感病毒抗体水平。以血凝抑制抗体滴度≥1：10判为阳性,滴度≥1：40判为有保护性作标准。结果：监测期间疫情基本平稳,2001年冬曾出现一个流感样病例发病高峰,同时伴随肺炎发病增高。发病构成≤14岁占90．71％．≥60岁较低。2001年10月～2002年3月分离出2株甲1型流感病毒．型别为A1／沪防／7／99;2002年10月～2003年3月分离出流感病毒7株。型别均为B型,其中6株为B／Yamanashi／166／98,1株为B／Victoria。毒株分离出时间与流感样病例发病高峰相一致,标本源于13岁以下患者。人群抗体监测,甲3型流感抗体水平较高,抗体阳性率≥87．05％;甲1型抗体阳性率偏低≤27．38％;乙型抗体阳性率2002年为21．13％。明显低于2001年的74．85％。结论：本地人群对甲1和乙型流感缺乏免疫力,下一流行季节存在甲1和乙型流感流行的可能。