West Nile virus activity--United States, July 28-August 3, 2004

During July 28-August 3, a total of 141 cases of human West Nile virus (WNV) illness were reported from 11 states (Alabama, Arizona, California, Colorado, Florida, Illinois, Nevada, New York, North Dakota, South Dakota, and Texas). During 2004, a total of 20 states have reported a total of 406 cases of human WNV illness to CDC through ArboNET. Of these, 247 (61%) were reported from Arizona. A total of 226 (57%) of the 406 cases occurred in males; the median age of patients was 51 years (range: 1 month-99 years). Illness onset ranged from April 20 to July 29; seven cases were fatal.     

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.     

Outbreak of aflatoxin poisoning--eastern and central provinces, Kenya, January-July 2004

In May 2004, CDC Kenya, trainees of the CDC-supported Field Epidemiology and Laboratory Training Program (FELTP) in Kenya, the World Health Organization, and CDC were invited by the Kenya Ministry of Health (KMOH) to participate in the investigation of an outbreak of jaundice with a high case-fatality rate (CFR) in the districts of Makueni and Kitui, Eastern Province. Preliminary laboratory testing of food collected from the affected area revealed high levels of aflatoxin, suggesting that the outbreak was caused by aflatoxin poisoning, as was a previous outbreak in the same area in 1981. In the United States, aflatoxin concentrations are limited to 20 parts per billion (ppb), a level also adopted by Kenyan authorities. The 2004 outbreak resulted from widespread aflatoxin contamination of locally grown maize, which occurred during storage of the maize under damp conditions. Urgent replacement of the aflatoxin-contaminated maize with noncontaminated maize proved to be a critical intervention; however, as of July 21, a limited number of new cases continued to be detected. This report summarizes the preliminary results of the outbreak investigation. Aflatoxin poisoning likely will continue to be a public health problem until culturally appropriate storage methods for dry maize are implemented by the local population. In addition, enhanced surveillance for human aflatoxin poisoning and testing of commercially sold maize for aflatoxin levels will lead to long-term improvements in public health.     

West Nile virus activity--United States, August 11-17, 2004

During August 11-17, a total of 194 cases of human West Nile virus (WNV) illness were reported from 17 states (Alabama, Arizona, California, Colorado, Florida, Illinois, Louisiana, Maryland, Minnesota, Mississippi, Missouri, New Mexico, Ohio, South Dakota, Texas, Utah, and Virginia).     

Tuberculosis outbreak in a community hospital--District of Columbia, 2002

After declining for nearly 30 years, during 1985-1992, tuberculosis (TB) rates in the United States experienced a resurgence, and several large nosocomial TB outbreaks occurred. Although data on such outbreaks are not collected systematically by CDC, the occurrence of nosocomial TB is believed to have declined sharply since the issuance and widespread implementation of infection-control guidelines in 1994. During April 2-September 12, 2002, TB was diagnosed in six persons who either had been patients or had worked in a large community hospital (hospital A) in March or early April. This report describes the results of an investigation of the presumed source patient, who had spent 3 weeks on two general medical wards of hospital A before being placed in respiratory isolation and having TB diagnosed on April 2. To prevent transmission of Mycobacterium tuberculosis, hospital staff should remain vigilant to identify and treat suspected TB cases promptly.     

Progress toward global eradication of dracunculiasis, 2002-2003

In 1986, when the World Health Assembly adopted a resolution calling for the eradication of dracunculiasis (i.e., Guinea worm disease), an estimated 3.5 million cases occurred in 20 countries, and 120 million persons were at risk for the disease. This report describes the status of the global dracunculiasis eradication program (DEP) as of the end of 2003. The findings indicate substantial overall progress towards eradication in 2003 compared with 2002, a major reduction in cases in Sudan, and an increase in cases in Ghana. Further progress will require 1) increased surveillance in all areas in which dracunculiasis is endemic or was previously endemic, 2) access to areas that lack security, and 3) concentrated efforts in Sudan once peace is achieved.     

Acute hemorrhagic conjunctivitis outbreak caused by Coxsackievirus A24--Puerto Rico, 2003

Acute hemorrhagic conjunctivitis (AHC) is an epidemic form of highly contagious conjunctivitis and is characterized by sudden onset of painful, swollen, red eyes, with conjunctival hemorrhaging and excessive tearing. Since 1981, when AHC was first detected in the Western Hemisphere, three major epidemics had occurred until 2003, all affecting the Caribbean. During August-October 2003, a fourth epidemic occurred in Puerto Rico (2000 population: 3.8 million). This report summarizes the outbreak investigation conducted by the Puerto Rico Department of Health (PRDOH), which documented an estimated 490,000 persons with illness, including >51,000 cases reported by physicians; demonstrated laboratory evidence of Coxsackievirus A24 (CA24); and determined that school-aged children (i.e., aged 5-18 years) and those living in crowded urban areas were at highest risk. To control outbreaks of AHC, prevention methods (e.g., frequent hand washing and avoidance of sharing towels and bedding) should be targeted to groups at highest risk, and information should be disseminated after the first report of AHC in the area.     

Rapid community health and needs assessments after Hurricanes Isabel and Charley--North Carolina, 2003-2004

On September 18, 2003, Hurricane Isabel, a Category 2 hurricane, made landfall on the Outer Banks of North Carolina (NC). The storm, moving to the northeast with winds exceeding 100 mph, caused extensive power outages and structural damage in northeastern NC and southern Virginia. In NC, approximately 762,000 residents lost power during the storm, and the shelter population peaked at an estimated 16,600 persons. Six storm-related fatalities were reported, and 26 eastern NC counties were included in a federal disaster area declaration. The North Carolina Division of Public Health (NCDPH) activated the Office of Public Health Preparedness and Response (PHPR) and seven Public Health Regional Surveillance Teams (PHRSTs) to conduct a rapid community health and needs assessment for the affected population. CDC deployed staff to provide technical support to NCDPH. The assessment determined that the majority of public health emergencies resulted from electric power outages, which affected access to food, water, and medical care. Data and recommendations were provided immediately to local and state emergency responders, who used the information to direct Hurricane Isabel recovery efforts and also to improve the assessment, which was next deployed in August 2004 with Hurricane Charley.     

Effect of revised population counts on county-level Hispanic teen birthrates--United States, 1999

In 2002, teen birthrates for Hispanics were higher than for all other racial/ethnic populations. Because of the health and social risks associated with teen births, pregnancy prevention programs and accurate surveillance of teen birthrates are critical. To assess the effect of using revised population estimates for the 1990s (intercensal estimates) that take into account both the 1990 and 2000 U.S. Census counts, CDC analyzed county-level estimates of Hispanic teen birthrates for 1999. This report summarizes the results of that analysis, which indicated that Hispanic teen birthrates for 1999, when calculated on the basis of the 2000 census, were lower than birthrates based on the 1990 census for the majority of counties with substantial Hispanic populations. Population estimates for 1999 based on the 1990 census (postcensal estimates) had failed to capture the unprecedented and unanticipated migration of Hispanics, thereby overestimating the Hispanic teen birthrate. However, the increase in the Hispanic teen population and the corresponding decrease in Hispanic teen birthrates for 1999 were not experienced by all counties. This county-level variation provides essential information for programs targeting Hispanic teens at the county level.     

State estimates of neonatal health-care costs associated with maternal smoking--United States, 1996

Smoking during pregnancy can cause poor outcomes for both the pregnant woman and her unborn child and also result in added health-care expenditures. To characterize costs by state, CDC analyzed pregnancy risk surveillance and birth certificate data to estimate the association between maternal smoking and the probability of infant admission to a neonatal intensive care unit (NICU). Neonatal health-care costs, in 1996 dollars, were assigned on the basis of data from private health insurance claims. This report summarizes the results of that analysis, which estimated smoking-attributable neonatal expenditures (SAEs) of 366 million dollars in the United States in 1996, or 704 dollars per maternal smoker, and indicated wide variations in SAEs among states. These costs are preventable. States can use these data to justify or support their prevention and cessation treatment strategies.