Q fever--California,Georgia, Pennsylvania,and Tennessee, 2000-2001

Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii. The most common reservoirs are domesticated ruminants, primarily cattle, sheep, and goats. Humans acquire Q fever typically by inhaling aerosols or contaminated dusts derived from infected animals or animal products. Its highly infectious nature and aerosol route of transmission make C. burnetii a possible agent of bioterrorism. Although up to 60% of initial infections are asymptomatic, acute disease can manifest as a relatively mild, self-limited febrile illness, or more moderately severe disease characterized by hepatitis or pneumonia. It manifests less commonly as myocarditis, pericarditis, and meningoencephalitis. Chronic Q fever occurs in <1% of infected patients, months or years after initial infection. Chronic disease manifests most commonly as a culture-negative endocarditis in patients with valvular heart disease. During 2000-2001, a total of 48 patients who met the case definition of Q fever were reported to CDC. This report describes the case investigations for six of these patients, which indicate that these persons acquired Q fever probably through direct or indirect contact with livestock. To enhance surveillance efforts, health-care providers should report cases of Q fever to state health departments.     

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.     

Enterovirus surveillance--United States, 2000-2001

Enteroviruses are common viruses associated with diverse clinical manifestations ranging from mild febrile illness to severe and potentially fatal syndromes including aseptic meningitis, encephalitis, neonatal systemic enteroviral disease, and paralytic poliomyelitis. A total of 64 enterovirus serotypes are recognized, including 61 nonpolio enteroviruses. Individual serotypes have different temporal patterns of circulation and often are associated with different clinical manifestations. This report describes temporal trends in reported enterovirus infections in the United States during 2000-2001, including widespread activity of two serotypes (echoviruses 13 and 18) that previously were detected rarely. Monitoring of circulating enterovirus serotypes helped identify these two agents as the primary causes of aseptic meningitis outbreaks in the United States in 2001. Further improvements in timeliness of reporting and geographic representation of the system are needed to allow more complete surveillance for enteroviruses.     

Prevalence of self-reported arthritis or chronic joint symptoms among adults--United States, 2001

Arthritis and other rheumatic conditions comprise the leading cause of disability among adults in the United States, and the cost of this public health burden is expected to increase as the U.S. population ages. State-specific estimates of the prevalence of arthritis and chronic joint symptoms (CJS) are important for planning health services and programs to prevent arthritis-related disability and for tracking progress toward meeting state and national health objectives for 2010. In 2001, questions about arthritis and CJS were asked of adult respondents in every state through the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that survey, which indicate that the estimated U.S. prevalence of arthritis/CJS was 33.0% among adults. Increased intervention efforts, including early diagnosis and appropriate clinical and self-management (e.g., physical activity, education, and maintaining appropriate weight), are needed to reduce the impact of arthritis and CJS.     

Update: Outbreak of poliomyelitis--Dominican Republic and Haiti, 2000-2001

From July 12, 2000, through September 18, 2001, a total of 21 cases of poliomyelitis (including two fatal cases) were reported from the Caribbean island of Hispaniola, divided between Haiti and the Dominican Republic. In the Dominican Republic, 13 of 168 reported cases of acute flaccid paralysis (AFP) were confirmed as polio by isolation of poliovirus type 1 from either patients or their healthy contacts. The median age of the patients was 3 years (range: 9 months-14 years). None was vaccinated adequately. The most recent confirmed case-patient in the Dominican Republic had paralysis onset on January 25, 2001. In Haiti, eight of 40 AFP cases were confirmed virologically; seven of the confirmed cases occurred during January-July 2001. The median age of the patients was 7 years (range: 2-12 years). One patient had received at least 3 doses of oral poliovirus vaccine (OPV). The most recent confirmed case occurred in Haiti and the patient had paralysis onset on July 12, 2001. Eighteen AFP cases from the Dominican Republic and three from Haiti are pending final classification.     

Primary and secondary syphilis--United States, 2000-2001

In October 1999, CDC, in collaboration with other federal partners, initiated the National Plan to Eliminate Syphilis in the United States. Syphilis elimination is defined as the absence of sustained transmission (i.e., no transmission after 90 days of the report of an imported index case). The national goals for syphilis elimination are to reduce the annual number of primary and secondary (P&S) syphilis cases to <1,000 cases (rate: 0.4 per 100,000 population) and to increase the number of syphilis-free counties to 90% by 2005. To characterize the epidemiology of syphilis in the United States, CDC analyzed national notifiable disease surveillance data for 2000-2001. This report summarizes the results of that analysis, which indicate that the number of reported cases of P&S syphilis increased slightly in 2001. This increase occurred only among men; the number of P&S syphilis cases continued to decline among women and among non-Hispanic blacks. The available data indicate that syphilis cases occurring among men who have sex with men (MSM) contributed to the increase in cases. The data suggest that, although efforts to reduce syphilis among women and non-Hispanic blacks appear effective and should continue, efforts to prevent and treat syphilis among MSM need to be improved.     

Income, relative income, and self-reported health in Britain 1979-2000

We test the relative income hypothesis that an individual's health depends on the distribution of income in a reference group, as well as on the income of the individual. We use data on 231 208 individuals in Great Britain from 19 rounds of the General Household Survey between 1979 and 2000. Results are insensitive to the measure of self-assessed health used but the sign and significance of the effect of relative income depend on the reference group (national or regional) and the measure of relative income (Gini coefficient, absolute or proportional difference from the reference group mean, Yitzhaki absolute and proportional relative deprivation and affluence). Only one model (relative deprivation measured as income proportional to regional mean income) performs better than the model without relative income and has a positive estimated effect of absolute income on health. In this model the increase in the probability of good health from a ceteris paribus reduction in relative deprivation from the upper quartile to zero is 0.010, whereas an increase in income from the lower to the upper quartile increases the probability by 0.056. While our results provide only very weak support for the relative deprivation hypothesis, the inevitable correlation of measures of individual income and relative deprivation measured by comparing income and incomes in a reference group makes identification of the separate effects of income and relative deprivation problematic.     

Multiple-race mortality data for California, 2000-2001

OBJECTIVES: To examine mortality rates and quality of race reporting for multiple-race individuals in California using the new multiple-race data available on the death certificate. METHODS: Death date were drawn from California vital statistics for 2000 and 2001. Denominator data were drawn from the 2000 census Modified Race Data Summary File. The authors calculated mortality rates and relative standard errors for multiple-race individuals as a whole and by county, and for the three largest reported multiple-race groups (African American and white, American Indian/Alaska Native and white, and Asian and white). RESULTS: Decedents reported to be of more than one race were disproportionately young, Hispanic, male, and never-married. Age-adjusted mortality rates for multiple-race groups were approximately one-sixth as high as rates for single-race individuals. There was substantial variability in rates for multiple-race decedents according to county of residence. CONCLUSIONS: Mortality rates for multiple-race people were implausibly low, and death certificates for multiple-race individuals were geographically clustered. Race reporting on death certificates will need to be improved before accurate death rates can be calculated for those of multiple races.     

Physical activity and physical function improved following a community-based intervention in older adults in Georgia senior centers

We evaluated a community-based physical activity intervention in Georgia senior centers. Participants were a convenience sample that completed the pre-test only (n = 592), or the pre-test, the intervention, and a post-test (n = 418, 98% aged 60 and older, mean age = 75, 83% female, 56% black). The 4-month physical activity intervention, based on the Health Belief Model, included 16 sessions that focused on educator-led chair exercises, promotion of walking, using a pedometer, and recording daily steps. Pre- and post-tests assessed physical activity and physical function, categorized as poor, moderate, or good (Short Physical Performance Battery). Following the intervention, participants improved their physical function (good physical function at pre-test vs. post-test: 16.5% vs. 25.3%, P < or = 0.001), increased minutes of physical activity by 26% (P < or = 0.001) and step counts by 29% (P < or = 0.0001, sub-sample, n = 95), and decreased reports of "it's not safe" as a barrier to physical activity (P < or = 0.05). Increased physical activity (P < or = 0.01) was associated with improved physical function following the intervention. The results of this evaluation provide an evidence base for the effectiveness of this community intervention for improving physical activity and physical function in older adults.     

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.     

Secular trends in self-reported violent activity among Ontario students, 1983-2001

INTRODUCTION: This paper examines secular trends in violence among Ontario students between 1983 and 2001, and variation by sex. METHODS: Using data from the Ontario Student Drug Use Survey, we examined self-reports of assault, weapon carrying, and gang fighting based on 10 cross-sectional surveys from 1983 to 2001. Respondents were derived from representative samples of Ontario students in grades 7, 9, 11, and 13 (OAC) who completed in-class anonymous self-administered surveys. Data were weighted to account for the complex survey design and analyzed using logit trend analyses. RESULTS: Short-term trends (1991-2001) showed assault, weapon carrying, and gang fighting have been on downward trajectories since the mid-1990s, reaching the lowest prevalence in 2001 among males and females. Long-term trends (1983-2001) among 11th-graders showed assault increased between 1985 and 1999, but declined in 2001. Gang fighting among males increased during the late 1980s and again during the mid-1990s, but declined between 1997 and 2001. Gang fighting among females remained at a stable, low level. DISCUSSION: Future monitoring is necessary to understand whether the decline in self-reported violent behaviour among adolescents is robust.     

Laboratory surveillance for wild poliovirus and vaccine-derived poliovirus, 2000-2001

After the 1988 World Health Assembly resolution to eradicate poliomyelitis, the Global Laboratory Network for Poliomyelitis Eradication (the laboratory network) was established by the World Health Organization (WHO). The laboratory network is one component of the international surveillance system for detecting polio through notification of cases of acute flaccid paralysis (AFP). As progress is made in eradicating polio worldwide, the laboratory network provides critical virologic evidence about where poliovirus is circulating as a guide to supplementary vaccination activities aimed at interrupting transmission. This report summarizes the laboratory data for documenting the decline in wild poliovirus transmission and the occurrence of vaccine-derived polioviruses and highlights the expanding role of the laboratory network in global polio eradication.     

Diabetes self-management behaviors and A1c improved following a community-based intervention in older adults in Georgia senior centers

A community-based intervention to improve diabetes self-management (DSM) and decrease A1c in older adults with diabetes from Georgia senior centers was evaluated. Participants were a convenience sample that completed the pre-test questionnaire only (N = 351) and a subset that completed the pre-test, intervention, and post-test questionnaires and A1c measurements (n = 144, mean age = 74 years, 84% female, 42% white, 57% black). Incorporating principles of the Health Belief Model and National Standards for DSM, the 4-month intervention consisted of eight sessions focused on improving daily adherence to DSM behaviors and included physical activity. At the post-test, several DSM behaviors increased by > or = 1 day/week: following a healthy eating plan, following an eating plan prescribed by their doctor, eating five or more servings of fruits and vegetables daily, spacing carbohydrates, and inspecting the insides of shoes (P < or = 0.0001). The mean decrease in A1c for the entire sample was 0.25% (SD = 0.82, P < or = 0.001, n = 144) and those with an initial A1c > 8% had a clinically significant mean decrease of 1.15% (SD = 1.09, pre-test: 9.48% vs. 8.33%, P < or = 0.001, n = 24). Increased physical activity was the DSM behavior consistently associated with decreased A1c in regression analyses (P < or = 0.05). The results of this evaluation provide an evidence base for the effectiveness of this community intervention in decreasing A1c and improving DSM behaviors in older adults.     

Prenatal HIV testing and antiretroviral prophylaxis at an urban hospital--Atlanta, Georgia, 1997-2000

In 1994, the U.S. Public Health Service (USPHS) recommended the use of zidovudine (ZDV) to reduce perinatal human immunodeficiency virus (HIV) transmission; in 1995, USPHS recommended universal prenatal HIV counseling and voluntary testing. Widespread implementation of these recommendations, together with increased use of antiretroviral therapy (ART) and scheduled cesarean delivery, has resulted in substantial declines in perinatal HIV transmission. However, perinatal HIV transmission continues to occur. To identify missed prevention opportunities, CDC analyzed the incidence of perinatal HIV infection among a cohort of HIV-exposed infants born during 1997-2000 at Grady Memorial Hospital (GMH) in Atlanta, Georgia. This report describes the results of that analysis and underscores the challenges to universal prevention of infant HIV infections. Efforts to reduce perinatal HIV transmission should focus on increasing prenatal care rates, promoting adherence to recommended treatment regimens during pregnancy, and increasing prenatal HIV testing, particularly in areas where missed opportunities for prevention of perinatal HIV transmission persist.     

Tuberculosis outbreak on an American Indian reservation--Montana, 2000-2001

During May 2000-January 2001, five tuberculosis (TB) cases, linked by contact and DNA fingerprinting, were reported from the Fort Belknap Indian Reservation in rural Montana. Before this, only one case of TB had been reported from the reservation since 1992. To determine the cause of the outbreak, the Fort Belknap Tribal Health Department and the Indian Health Service (IHS) conducted an investigation and requested assistance from the Montana State Department of Public Health and Human Services (DPHHS) and CDC to improve case finding and medical management of persons with TB. This report summarizes the results of the investigation and demonstrates how, in low incidence areas, rapid expansion of local capacity for TB control is critical to eliminate TB in the United States.     

Prevalence and impact of asthma in children,Georgia, 2000

BACKGROUND: Asthma is a common chronic condition with significant impact on those who have it. Information about children with asthma was sought to guide state program planning. METHODS: A random-digit-dial telephone survey of 1503 households with 2700 children was conducted in Georgia. Primary caretakers were interviewed. Results for households, children, and caretakers were weighted by number of telephone lines; results for children were also weighted to the Georgia 1998 estimated population. Data were collected and analyzed in 2000. RESULTS: Asthma prevalence among children in Georgia aged 0 to 17 years was 10.5% (95% confidence interval [CI]=9.2%-11.9%). Among children with asthma, 64.8% (95% CI= 58.5-71.1) had an attack and 30.0% (95% CI=24.2-35.8) visited an emergency department in the last year. In the past year, 53.9% (95% CI=46.8-61.0) of school-aged children with asthma and 29.7% (95% CI=23.7-35.7) of adults in households of children with asthma missed school or work because of the child's asthma. Among children with asthma, 56.1% (95% CI=48.6-63.6) lived in a household where neither caretaker nor child has taken a course or been taught about managing asthma, and 28.6% (95% CI=22.1-35.1) lived in a household where adults smoked inside the house. CONCLUSIONS: Asthma has a substantial effect on the lives of children in Georgia, including medical events and missed school, and on adult caretakers in terms of missed work due to the child's asthma. To reduce the burden of asthma in Georgia, exposure of people with asthma to tobacco smoke in the home should be eliminated and training in asthma management should be more widely available.