Giardiasis surveillance--United States, 1992-1997.

PROBLEM/CONDITION: Giardia intestinalis, the organism that causes the gastrointestinal illness giardiasis, is the most commonly diagnosed intestinal parasite in public health laboratories in the United States. In 1992, the Council of State and Territorial Epidemiologists assigned giardiasis an event code that enabled states to begin voluntarily reporting surveillance data on giardiasis to CDC. REPORTING PERIOD: This report includes data that were reported from January 1992 through December 1997. DESCRIPTION OF THE SYSTEM: The National Giardiasis Surveillance System includes data about reported cases of giardiasis from participating states. Because most states were already collecting data on occurrence of giardiasis, the assignment of an event code to giardiasis has allowed voluntary reporting of these data to CDC via the National Electronic Telecommunications System for Surveillance. RESULTS: Since 1992, the number of states reporting cases of giardiasis to CDC has risen from 23 to 43. The annual number of giardiasis cases reported has ranged from 12,793 in 1992 to 27,778 in 1996. In 1997, cases per 100,000 state population ranged from 0.9 to 42.3, with 10 states reporting >20.0 cases per 100,000 population and a national average of 9.5 cases per 100,000 population. In 1997, New York State, including New York City, reported the highest number of cases (3,673, or 20.3 cases per 100,000 population), accounting for 14.5% of cases nationally; however, Vermont reported the highest incidence rate in 1997 (42.3 cases per 100,000 population). Both states have active surveillance systems in place for giardiasis. Cases have an approximately equal sex distribution. Nationally, rates were the highest among children aged 0-5 years, followed closely by persons aged 31-40 years. In these two age groups, most cases were reported during late summer and early fall--an indication that transmission occurred during the summer. INTERPRETATION: This report documents the first nationwide look at epidemiologic parameters and disease burden estimates for giardiasis in the United States. Transmission occurs in all major geographic areas of the country. The seasonal peak in age-specific case reports coincides with the summer recreational water season and might reflect the heavy use by young children of communal swimming venues (e.g., lakes, rivers, swimming pools, and water parks)--a finding consistent with Giardia's low infectious dose, the high prevalence of diaper-aged children in swimming venues, the extended periods of cyst shedding that can occur, and Giardia's environmental resistance. Estimates based on state surveillance data indicate that as many as 2.5 million cases of giardiasis occur annually in the United States. PUBLIC HEALTH ACTION: Giardiasis surveillance provides data to educate public health practitioners and health-care providers about the scope and magnitude of giardiasis in the United States. These data can be used to establish research priorities and to plan future prevention efforts.     

Surveillance for use of preventive health-care services by older adults, 1995-1997.

PROBLEM/CONDITION: In 1995, a total of 55 million persons aged > or =55 years lived in the United States. The members of this large and growing segment of the population are major consumers of health care. Their access to medical and dental preventive services contributes to their likelihood of healthy later years and influences their long-term impact on the health-care delivery system. REPORTING PERIOD: 1995-1997. DESCRIPTION OF SYSTEMS: This report summarizes data from the National Health Interview Survey (NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare Current Beneficiary Study (MCBS) to describe national, regional, and state-specific patterns of access to and use of preventive services among persons aged > or =55 years. RESULTS: During 1995-1997, approximately 90% of persons aged > or =55 years living in the United States reported having a regular source of health-care services. However, only 75%-80% reported receiving a routine checkup during the preceding 2 years. The estimated percentage of persons who reported not being able to receive medical care because of cost was highest for those aged 55-64 years. Within this age group, the percentage was highest among Hispanics (4%) and persons without a high school diploma. Approximately 11% of Medicare beneficiaries reported delaying care be cause of cost or because they had no particular source of care. Percentage estimates varied according to age, race/ethnicity, and sociodemographic status. Approximately 95% of persons aged > or =55 years reported having their blood pressure checked during the preceding 2 years, but only 85%-88% had received a cholesterol evaluation during the preceding 5 years. The percentage of women receiving breast and cervical cancer screening decreased with increasing age, and the percentage of persons aged > or =55 years who had received some form of screening for colorectal cancer was low approximately 25% for fecal occult blood testing (FOBT) and 45% for endoscopy. State-specific rates of compliance with vaccination recommendations among persons aged > or =65 years were higher for influenza vaccine (range: 54%-74%) than for pneumococcal vaccine (range: 32%-59%), and compliance increased with advancing age. State-specific estimates of the percentage of annual dental visits varied 40%-75%, and 41%-88% of persons aged > or =65 years reported not having dental insurance. INTERPRETATION: Access to medical services among adults living in the United States is greater for persons aged > or =65 years, compared with those aged <65 years, presumably because of Medicare coverage. In contrast, use of dental services decreased, despite increased need for preventive and restorative dental care. Although Medicare covers many medical services for older adults, financial, personal, and physical barriers to both medical and dental care create racial, regional, and sociodemographic disparities in health status and use of health services in the United States. PUBLIC HEALTH ACTION: Continued surveillance of access to and use of health services among older adults (i.e., persons aged > or =65 years), as well as among persons aged 55-64 years, will help health-care providers target underserved groups, make Medicare coverage decisions, and develop public health programs to ensure equitable access to services and improve the health of older adults.     

Surveillance of acute flaccid paralysis in The Netherlands, 1992-94.

Detection and investigation of all cases of acute flaccid paralysis (AFP) in children below 15 years of age are among the criteria for poliomyelitis-free certification. In the absence of poliomyelitis the incidence of AFP is around 1 per 100,000 children aged < 15 years. In the Netherlands, surveillance of AFP began in October 1992 under the supervision of the Dutch Paediatric Surveillance System (NSCK). Over 90% of clinically active paediatricians participated in the monthly reporting of new cases of AFP. From October 1992 to December 1994 (27 months), 52 cases of AFP were reported. The incidence was 0.7 per 100,000 over the period, and reported cases were evenly distributed throughout the country. The main cause of AFP was Guillain-Barré syndrome. The average time between onset of symptoms and visiting a doctor was less than 3 days. The median reporting delay was 29 days, although the system was not intended as surveillance for action. Virological examination of faeces was carried out for only 40.4% of AFP patients. The start of the NSCK surveillance system coincided with the 1992-93 outbreak of poliomyelitis in the Netherlands, but only 7 of the 18 children with paralytic poliomyelitis were reported through the AFP surveillance system. For certification purposes, the present AFP surveillance system in the Netherlands needs to be improved with respect to coverage by including neurologists, rapidity of reporting, and completeness of laboratory investigations.     

Typhoid and paratyphoid fever in south-eastern Sydney, 1992-1997

Notification records of typhoid and paratyphoid cases among residents of south-eastern Sydney during 1992-1997 were reviewed, with particular attention paid to identifying a source of infection and to completeness of follow up. Notifications comprised 30 cases of Salmonella Typhi, nine of S. Paratyphi A and five of S. Paratyphi B. These 44 cases had a median age of 20 years (range 2-62). Of the 39 cases with known country of birth, 30 were born overseas, predominantly in Asian countries. Of 39 cases with a known travel history, 33 were cases of overseas-acquired acute infection and two cases were asymptomatic chronic carriers. A source was identified in only one of four domestically acquired infections. Of eight household contacts in occupations posing a public health risk (seven food-handlers and one health-care worker), complete follow-up information was available for only five. Most cases were in overseas-born individuals who may have been infected when returning to their country of birth. Explicit follow-up protocols need to cover appropriate clinical management (including treatment of chronic carriage) and monitoring of those cases and contacts who could pose a public health risk.     

Reporting race and ethnicity data--National Electronic Telecommunications System for Surveillance, 1994-1997

Reporting accurate and complete race and ethnicity data in public health surveillance systems provides critical information to target and evaluate public health interventions, particularly for minority populations. A national health objective for 2000 is to improve data collection on race and ethnicity in public health surveillance and data systems. To determine progress toward meeting this goal in CDC's National Electronic Telecommunications System for Surveillance (NETSS), the percentage of case reports of selected nationally notifiable diseases reported through NETSS with information regarding a patient's race and ethnicity was calculated for 1994-1997. The findings of this study indicate these data were received for approximately half of the cases, and the completeness of reporting of race and ethnicity data to NETSS had not improved.     

咸宁市咸安区1992～2005年血吸虫病监测结果分析

咸宁市咸安区位于鄂东南,总人口46.5万人,全区12个乡镇(场),260个行政村,其中血吸虫病流行乡镇4个,行政村12个,流行村人口4.1万人,全区累计查出血吸虫病人2130人,血吸虫病牛244头,查出钉螺面积539.34m2。经过几十年防治,1991年全区达到血吸虫病传播阻断标准,转入监测阶段后,199     

Uses of Behavioral Risk Factor Surveillance System data, 1993-1997

OBJECTIVES: The purpose of this study was to document and describe Behavioral Risk Factor Surveillance System (BRFSS) data use patterns, benefits, and barriers from 1993 to 1997. METHODS: Data use information was gathered via a Medline database search and a telephone survey of BRFSS program directors (n = 54). RESULTS: The database search uncovered 109 BRFSS-based reports. Program directors indicated that BRFSS data frequently were used to support health policies regarding diabetes, physical activity, and smoking. Frequent data use barriers included insufficient special population data, insufficient city- or county-specific data, and insufficient staff. CONCLUSIONS: Use of BRFSS data, which aid several state health activities, increased from 1993 to 1997.     

Surveillance for unexplained deaths and critical illnesses due to possibly infectious causes, United States, 1995-1998

Population-based surveillance for unexplained death and critical illness possibly due to infectious causes (UNEX) was conducted in four U.S. Emerging Infections Program sites (population 7.7 million) from May 1, 1995, to December 31, 1998, to define the incidence, epidemiologic features, and etiology of this syndrome. A case was defined as death or critical illness in a hospitalized, previously healthy person, 1 to 49 years of age, with infection hallmarks but no cause identified after routine testing. A total of 137 cases were identified (incidence rate 0.5 per 100,000 per year). Patients' median age was 20 years, 72 (53%) were female, 112 (82%) were white, and 41 (30%) died. The most common clinical presentations were neurologic (29%), respiratory (27%), and cardiac (21%). Infectious causes were identified for 34 cases (28% of the 122 cases with clinical specimens); 23 (68%) were diagnosed by reference serologic tests, and 11 (32%) by polymerase chain reaction-based methods. The UNEX network model would improve U.S. diagnostic capacities and preparedness for emerging infections.     

Hydrogen peroxide in the aqueous humor: 1992-1997

Ideas prevailing in 1991 on hydrogen peroxide in the aqueous humor are outlined. They are critically examined under the light of our finding that the method used to establish aqueous humor levels of peroxide generates itself peroxide during the short time span of the analysis. This is due to the fact that the probe used, dichlorophenol indophenol (DCPIP), spontaneously auto-oxidizes in the presence of oxygen. It was concluded then that the level of hydrogen peroxide in the aqueous humor cannot be higher than about 0.3 microM, the detection limit of the DCPIP method. It was also concluded that the statement commonly made in the literature that aqueous humor hydrogen peroxide derives from the oxidation of ascorbate, an abundant component of that fluid, is based solely on the use of the DCPIP method, and so could easily be due to a methodological artifact. The same applies to the statement that the levels of hydrogen peroxide are very high in human senile cataracts. The surprising resistance to accept the results and conclusions of our 1992 publication is documented. Finally, the content is discussed of an oral presentation made at the 1997 ARVO Annual Meeting in which an important portion of our results and conclusions was confirmed, perhaps signaling a shift towards a wider acceptance of our findings.     

Surveillance for dracunculiasis, 1981-1991.

In 1986 the World Health Organization (WHO) designated dracunculiasis (guinea worm disease) as the next disease scheduled to be eradicated (by 1995) after smallpox. Dramatic improvement in national and international surveillance has played a key role in the global eradication campaign, which was initiated at CDC in 1980. About 3 million persons are still affected by the disease annually, with adverse effects on their health as well as on agricultural production and education. Over 100 million persons are at risk of having the disease in more than 20,000 villages in India, Pakistan, and 17 African countries. At least one nationwide, village-by-village search to detect all villages with endemic dracunculiasis and count cases is recommended at the outset of each national campaign, followed by monthly reporting by village-based health workers in the targeted villages during the implementation phase. Rapid dissemination of the results of the surveillance is critical. Intensive case detection and containment--with rewards for reporting of cases--are most appropriate near the end of each campaign. Cameroon, Ghana, India, Nigeria, and Pakistan have pioneered the various surveillance methods for this disease in recent years. Methods for conducting surveillance of dracunculiasis and other important diseases must continue to be developed and improved as countries now believed to be free of dracunculiasis prepare to apply to WHO for certification of elimination of dracunculiasis.     

Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults--United States, 1993-1997.

PROBLEM/CONDITION: Increases in life expectancy in the United States are accompanied by concerns regarding the cumulative impact of chronic disease and impairments on the prevalence of disability and the health status and quality of life of the growing number of older adults (defined as persons aged > or =65 years). Although older adults are the focus of these surveillance summaries, persons aged 55-64 years have also been included, when data were available, as a comparison. One important public health goal for an aging society is to minimize the impact of chronic disease and impairments on the health status of older adults, maintain their ability to live independently, and improve their quality of life. This report examines three dimensions of health status: sensory impairments, activity limitations, and health-related quality of life among older adults. REPORTING PERIOD: This report examines data regarding activity limitations and sensory impairments for 1994 and health-related quality of life for 1993-1997. DESCRIPTION OF SYSTEM: The 1994 National Health Interview Survey (NHIS) Core, NHIS disability supplement (NHIS-D1), and the 1994 NHIS Second Supplement on Aging (SOA II) were used to estimate vision impairments, hearing loss, and activity limitation. Data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993 through 1997 were used to estimate two general measures of health-related quality of life: a) the prevalence of self-rated fair or poor general health and b) the number of days during the preceding 30 days when respondents reported their physical or mental health was "not good." RESULTS: Sensory impairments are common among older adults. Among adults aged > or =70 years, 18.1% reported vision impairments, 33.2% reported hearing impairments, and 8.6% reported both hearing and vision impairments. Although older adults who reported vision and hearing impairments reported more comorbidities than their non-hearing-impaired and nonvisually impaired peers, impaired adults with sensory loss were able to sustain valued social participation roles. Advancing age was associated with increased likelihood of difficulty in performing functional activities and instrumental and basic activities of daily living, regardless of race/ethnicity, sex, and region of residence in the United States. Unhealthy days (a continuous measure of population health-related quality of life) was consistent with self-rated health (a commonly used categorical measure) and useful in identifying subtle differences among sociodemographic groups of older adults. An important finding was that adults aged 55-64 years with low socioeconomic status (i.e., less than a high school education or an annual household income of <$15,000) reported substantially greater numbers of unhealthy days than their peers aged 65-74 years. INTERPRETATION: Sensory impairments are common in adults aged > or =70 years, and prevalence of activity limitations among older adults is high and associated with advancing age. Health-related quality of life is less closely related to age, particularly when health-related quality of life includes aspects of mental health.     

凭祥市1997～2002年疟疾监测

[目的]了解凭祥市达到基本消灭疟疾标准后，所采取监测措施是否适合本地防治需要，为了巩固防治成果，总结防治经验，及今后疟疾防治工作提供科学依据。[方法]对临床诊断为疟疾，疑似疟疾．疑似感冒，原因不明的发热病人进行登记和血检；对确诊的疟疾病人进行根治;对病家及村组进行全民性的预防服药和用杀虫剂室内外滞留喷洒防止媒介按蚊，对接触病人的人群进行二代虫率的调查。对旧病灶点进行血清学荧光抗体试验；对外来流动人员和本地外出回归者进行登记和血检；并做按蚊分类鉴定。[结果]全市共血检“四热”病人11018人，疟疾内源性发病率为0。流动人口和当地居民外出回归者血检1335人次，输人性疟疾病人3例，阳性率为0．22％。血清荧光抗体调查2218人次，阳性率为0．05％。经卵、成蚊分类鉴定为中华按蚊、微小按蚊、日月潭按蚊分别占46．34％、20．73％、32．93％。[结论]今后继续开展疟疾监测，做好病例监测，重点是加强流动人口和本地外出回归者疟疾监测管理，同时继续做好血清IFA检测和防蚊灭蚊工作，以及广泛开展疟疾健康教育，提高群众对疟疾的防治意识。     

Surveillance of work-related carpal tunnel syndrome in Massachusetts, 1992-1997: a report from the Massachusetts Sentinel Event Notification System for Occupational Risks (SENSOR)

BACKGROUND: This surveillance study was undertaken to target efforts to prevent work-related carpal tunnel syndrome (WR-CTS) and to assess physician case-reports as a source of surveillance data. METHODS: Physician case-reports and workers' compensation disability claims were used to document patterns of WR-CTS in Massachusetts from March 1992 to June 1997 by age, gender, industry, occupation, and calendar year. Characteristics of cases identified through the two data sources were compared. RESULTS: 4,836 cases of WR-CTS were ascertained; 6% were identified by both data sources. Whereas the two sets of cases were similar with respect to age and occupation categories, physician-reported cases were more likely male and employed in manufacturing. The number of compensation claims filed by women declined over time, and a substantial number of cases under age 25 years were identified. Manufacturing workers had the highest rates; the highest numbers of cases were employed in hospitals, grocery stores, and the insurance industry. Several technical/administrative support occupations likely to use video display terminals had both high rates and frequencies. CONCLUSION: WR-CTS is a significant public health problem. Physician reports are useful in understanding problem magnitude and targeting specific establishments for intervention but are currently of limited use in targeting specific industries and occupations.