Birth Weight and Health and Developmental Outcomes in US Children, 1997�C2005

The primary goal of this study was to assess the association between the full birth weight distribution and prevalence of specific developmental disabilities and related measures of health and special education services utilization in US children. Using data from the 1997?C2005 National Health Interview Survey (NHIS) Sample Child Core, we identified 87,578 children 3?C17 years of age with parent-reported information on birth weight. We estimated the prevalences of DDs (attention-deficit/hyperactivity disorder [ADHD], autism, cerebral palsy, hearing impairment, learning disability without mental retardation, mental retardation, seizures, stuttering/stammering, and other developmental delay) and several indicators of health services utilization within a range of birth weight categories. We calculated odds ratios adjusted for demographic factors (AOR). We observed trends of decreasing disability/indicator prevalence with increasing birth weight up to a plateau. Although associations were strongest for very low birth weight, children with ??normal?? birth weights of 2,500?C2,999 g were more likely than those with birth weights of 3,500?C3,999 g to have mental retardation (AOR 1.9 [95% CI: 1.4?C2.6]), cerebral palsy (AOR 2.4 [95% CI: 1.5?C3.8]), learning disability without mental retardation (AOR 1.2 [95% CI: 1.1?C1.4]), ADHD (AOR 1.2 [95% CI: 1.1?C1.3]), and other developmental delay (AOR 1.3 [95% CI: 1.1?C1.5]) and to receive special education services (AOR 1.3 [95% CI: 1.2?C1.5]). While much research has focused on the health and developmental outcomes of low and very low birth weight children, these findings suggest that additional study of a continuous range of birth weights may be warranted.     

Effect of Winter School Breaks on Influenza-like Illness,Argentina, 2005–2008

School closures are used to reduce seasonal and pandemic influenza transmission, yet evidence of their effectiveness is sparse. In Argentina, annual winter school breaks occur during the influenza season, providing an opportunity to study this intervention. We used 2005–2008 national weekly surveillance data of visits to a health care provider for influenza-like illness (ILI) from all provinces. Using Serfling-specified Poisson regressions and population-based census denominators, we developed incidence rate ratios (IRRs) for the 3 weeks before, 2 weeks during, and 3 weeks after the break. For persons 5–64 years of age, IRRs were <1 for at least 1 week after the break. Observed rates returned to expected by the third week after the break; overall decrease among persons of all ages was 14%. The largest decrease was among children 5–14 years of age during the week after the break (37% lower IRR). Among adults, effects were weaker and delayed. Two-week winter school breaks significantly decreased visits to a health care provider for ILI among school-aged children and nonelderly adults.     

Rates of Influenza-like Illness and Winter School Breaks,Chile, 2004–2010

To determine effects of school breaks on influenza virus transmission in the Southern Hemisphere, we analyzed 2004–2010 influenza-like–illness surveillance data from Chile. Winter breaks were significantly associated with a two-thirds temporary incidence reduction among schoolchildren, which supports use of school closure to temporarily reduce illness, especially among schoolchildren, in the Southern Hemisphere.     

Changing Patterns of Human Campylobacteriosis, England and Wales, 1990�C2007

To explore hypotheses for age-related changes in the incidence of Campylobacter infections in England and Wales during 1990–2007, we analyzed electronic laboratory data. Disease incidence was reduced among children, and the greatest increase in risk was for those >60 years of age. Risk factors for campylobacteriosis in the elderly population should be identified.     

Vaccine-associated Paralytic Poliomyelitis in Immunodeficient Children, Iran, 1995�C2008

To determine the prevalence of vaccine-associated paralytic poliomyelitis (VAPP) in immunodeficient infants, we reviewed all documented cases caused by immunodeficiency-associated vaccine-derived polioviruses in Iran from 1995 through 2008. Changing to an inactivated polio vaccine vaccination schedule and introduction of screening of neonates for immunodeficiencies could reduce the risk for VAPP infection.     

Burden of Acute Gastrointestinal Illness in G��lvez, Argentina, 2007

This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the ‘high’ and the ‘low’ seasons of GI in the community. Comparisons were made between the annual incidence rates obtained using the seven-day and the 30-day recall period. Using the 30-day recall period, the mean annual incidence rates was 0.43 (low season of GI) and 0.49 (high season of GI) episodes per person-year. Using the seven-day recall period, the mean annual incidence rate was 0.76 (low season of GI) and 2.66 (high season of GI) episodes per person-year. This study highlights the significant burden of GI in a South American community and confirms the importance of seasonality when investigating GI in the population. The findings suggest that a longer recall period may underestimate the burden of GI in retrospective population surveys of GI.Key words: Cross-sectional studies, Developing country, Diarrhoea, Foodborne diseases, Morbidity, Population surveys, Recall bias, Waterborne diseases, Argentina     

Human Polyomaviruses in Children Undergoing Transplantation, United States, 2008�C2010

Immunocompromised patients are at risk for disease caused by infection by some polyomaviruses. To define the prevalence of polyomaviruses in children undergoing transplantation, we collected samples from a longitudinal cohort and tested for the 9 known human polyomaviruses. All were detected; several were present in previously unreported specimen types.     

Trends in Body Mass Index and Prevalence of Extreme High Obesity Among Pennsylvania Children and Adolescents, 2007–2011: Promising but Cautionary

Objectives. We determined current trends and patterns in overweight, obesity, and extreme high obesity among Pennsylvania pre-kindergarten (pre-K) to 12th grade students and simulated future trends.Methods. We analyzed body mass index (BMI) of pre-K to 12th grade students from 43 of 67 Pennsylvania counties in 2007 to 2011 to determine trends and to discern transition patterns among BMI status categories for 2009 to 2011. Vinsem simulation, confirmed by Markov chain modeling, generated future prevalence trends.Results. Combined rates of overweight, obesity, and extreme high obesity decreased among secondary school students across the 5 years, and among elementary students, first increased and then markedly decreased. BMI status remained constant for approximately 80% of normal and extreme high obese students, but both decreased and increased among students who initially were overweight and obese; the increase in BMI remained significant.Conclusions. Overall trends in child and adolescent BMI status seemed positive. BMI transition patterns indicated that although overweight and obesity prevalence leveled off, extreme high obesity, especially among elementary students, is projected to increase substantially over time. If current transition patterns continue, the prevalence of overweight, obesity, and extreme high obesity among Pennsylvania students in 2031 is projected to be 16.0%, 6.6%, and 23.2%, respectively.The economic consequences of obesity in the United States were estimated at $147 billion annually in 2008.1 To better understand these costs, obesity trends to the year 2030 were predicted.2 Obesity prevalence could reach 51% by 2030, but is more likely to stay at more than 40% because of recently emerging positive developments. A subcategory, severe obesity, that is, body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) of 40 or greater for adults, has increased faster than overall obesity and is projected to grow from 5% of adults in 2010 to 11% of adults by 2030.2 This growth, with its attendant increased risks of disease, will escalate costs even if overall obesity prevalence stabilizes.2Because obesity rates vary across states, the financial burden is not uniform.3 State-specific differences, such as lower cost of less healthy foods, can affect obesity and severe obesity prevalence together with current and projected health care costs.2 Because of the state-specific nature of Medicaid and Medicare expenditures, much of the high cost of obesity-related disease is borne by public sector health plans.Today’s children and adolescents will be the youngest adults in 2030; therefore, obesity prevention for the future requires monitoring of obesity prevalence rates among this population over time. Prevalence and trends in obesity among US children from 1999 to 2010 were determined based on National Health and Nutrition Examination Survey data.4 Prevalence of high BMI in US children and adolescents has also been studied.5 By 2010, fewer than 12% of those aged 2 to 19 years nationwide were at or above the 97th percentile (extreme high obese [ExHi obese]); 17% were above the 95th percentile (obese), and 32% were above the 85th percentile (overweight). A statistically significant increase among 6- to 19-year-old males with a BMI at or above the 97th percentile was found between 1999 and 2008.4To inform prevention efforts, state governments have a vested interest in monitoring obesity prevalence among all age groups, and especially among children and adolescents. Pennsylvania, for example, mandates annual height and weight screening with BMI calculation for all public school students statewide.6 One recent study assessed child and adolescent BMI trends in Pennsylvania, excluding Philadelphia and surrounding counties, for 2005 to 20097 and found combined overweight and obese rates decreased from 28.5% to 23.1% at the middle school level and from 24.6% to 20.9% at high school levels, but increased from 10.9% to 20% at the elementary level. The largest shift in BMI over the subset of years from 2007 to 2009 was among overweight elementary students; 58% of those who were overweight in 2007 were obese in 2009. Overweight and obese increased for the study population as a whole because of this sharp increase among elementary students. In a second, separate study,8 trends in obese (BMI ≥ 95th percentile) and ExHi obese (defined8 as BMI ≥ 35 kg/m²) among 5- to 18-year-old students attending Philadelphia schools in 2006 to 2010 were determined; obesity across all ages decreased from 21.5% to 20.5% and ExHi obese from 8.5% to 7.9%. Obese and ExHi obese were most prevalent among middle school students, Hispanic boys, and Black girls.8The purpose of our study was to determine prevalence, trends, and patterns in overweight, obese, and ExHi obese among Pennsylvania school children. Specific research questions were:

1. What were the prevalence and trends in overweight, obese, and ExHi obese from 2007 to 2011 among elementary, middle, and high school students?
2. What movement patterns, if any, occurred in normal weight, overweight, obese, and ExHi obese among Pennsylvania elementary, middle, and high school students from 2009 to 2011?
3. If current patterns continue, what percentage of children and adolescents would be overweight, obese, and ExHi obese in 2030?

     

Wild Birds and Urban Ecology of Ticks and Tick-borne Pathogens, Chicago, Illinois, USA, 2005�C2010

Bird-facilitated introduction of ticks and associated pathogens is postulated to promote invasion of tick-borne zoonotic diseases into urban areas. Results of a longitudinal study conducted in suburban Chicago, Illinois, USA, during 2005–2010 show that 1.6% of 6,180 wild birds captured in mist nets harbored ticks. Tick species in order of abundance were Haemaphysalis leporispalustris, Ixodes dentatus, and I. scapularis, but 2 neotropical tick species of the genus Amblyomma were sampled during the spring migration. I. scapularis ticks were absent at the beginning of the study but constituted the majority of ticks by study end and were found predominantly on birds captured in areas designated as urban green spaces. Of 120 ticks, 5 were infected with Borrelia burgdorferi, spanning 3 ribotypes, but none were infected with Anaplasma phagocytophilum. Results allow inferences about propagule pressure for introduction of tick-borne diseases and emphasize the large sample sizes required to estimate this pressure.     

Possible Interruption of Malaria Transmission, Highland Kenya, 2007�C2008

Highland areas where malaria transmission is unstable are targets for malaria elimination because transmission decreases to low levels during the dry season. In highland areas of Kipsamoite and Kapsisiywa, Kenya (population ≈7,400 persons), annual household indoor residual spraying with a synthetic pyrethroid was performed starting in 2005, and artemether/lumefantrine was implemented as first-line malaria treatment in October 2006. During April 2007–March 2008, no microscopy-confirmed cases of malaria occurred at the sites. In 4 assessments of asymptomatic persons during May 2007–April 2008, a total of <0.3% of persons were positive for asexual Plasmodium falciparum by microscopy or PCR at any time, and none were positive by PCR at the last 2 sample collections. Our findings show that in such areas, interruption and eventual elimination of malaria transmission may be achievable with widespread annual indoor residual spraying of households and artemisinin combination therapy.