Weekly update: West Nile virus activity--United States,July 17-23, 2002

This report summarizes West Nile virus (WNV) surveillance data reported to CDC through ArboNET and verified by states and other jurisdictions as of July 23, 2002. During the reporting week of July 17-23, nine human cases of WNV were reported from two states (Louisiana and Mississippi). During the same period, WNV infections were reported in 202 dead crows, 48 other dead birds, 13 horses, and 69 mosquito pools.     

Cigarette smoking among adults--United States, 2000

One of the national health objectives for 2010 is to reduce the prevalence of cigarette smoking among adults to < or = 12% (objective 27.1a). To assess progress toward this objective, CDC analyzed self-reported data from the 2000 National Health Interview Survey (NHIS) sample Adult Core questionnaire and Cancer Control module. This report summarizes the findings of this analysis, which indicate that, in 2000, approximately 23.3% of adults were current smokers compared with 25.0% in 1993, reflecting a modest but statistically significant decrease in prevalence among U.S. adults. In 2000, an estimated 70% of smokers said they wanted to quit, and 41% had tried to quit during the preceding year; however, marked differences in successful quitting were observed among demographic groups. A comprehensive approach to cessation that comprises economic, clinical, regulatory, and educational strategies is required to further reduce the prevalence of smoking in the United States.     

Populations receiving optimally fluoridated public drinking water--United States, 2000

Dental caries (i.e., tooth decay) is a transmissible, multifactor disease that affects 50% of children aged 5-9 years, 67% of adolescents aged 12-17 years, and 94% of adults aged > or = 18 years in the United States. During the second half of the 20th century, a major decline in the prevalence and severity of dental caries resulted from the identification of fluoride as an effective method of preventing caries. Fluoridation of the public water supply is the most equitable, cost-effective, and cost-saving method of delivering fluoride to the community. In the United States during 2000, approximately 162 million persons (65.8% of the population served by public water systems) received optimally fluoridated water compared with 144 million (62.1%) in 1992. This report presents state-specific data on the status of water fluoridation in the United States and describes a new surveillance system designed to routinely produce state and national data to monitor fluoridation in the public water supply. The results of this report indicate slow progress toward increasing access to optimally fluoridated water for persons using public water systems. Data from the new surveillance system can heighten public awareness of this effective caries prevention measure and can be used to identify areas where additional health promotion efforts are needed.     

Health-related quality of life--Puerto Rico, 1996-2000

Although a number of studies have been made to determine the health-related quality of life (HRQOL) of persons living in the United States, no overall assessment of HRQOL has been conducted previously for residents of Puerto Rico. To determine the HRQOL of adults living in Puerto Rico, during 1996-2000, as part of the Behavioral Risk Factor Surveillance System (BRFSS), interviews were conducted in Spanish with a representative sample of Puerto Rican adults. Older women, persons with less education or lower income, persons unable to work, and those who were overweight or who had diabetes or high blood pressure reported more days for which they were physically or mentally unhealthy during the 30 days preceding the survey. Interventions designed to reach these vulnerable, demographic, socioeconomic, and behavioral risk groups might help adults in Puerto Rico increase their quality and years of healthy life and eliminate health disparities.     

Local transmission of Plasmodium vivax malaria--Virginia, 2002

Malaria transmission in the United States was largely eliminated during the mid-20th century; however, sporadic cases of locally acquired mosquito-transmitted malaria continue to occur. Since 1997, four separate probable mosquito-transmitted malaria outbreaks have been reported to CDC, including one from Virginia. This report describes the investigation of two cases of Plasmodium vivax malaria that occurred in northern Virginia in August 2002, and underscores the need for clinicians to consider the possibility of malaria in patients with fever of unknown origin.     

Multistate outbreaks of Salmonella serotype Poona infections associated with eating cantaloupe from Mexico--United States and Canada, 2000-2002

Three multistate outbreaks of Salmonella serotype Poona infections associated with eating cantaloupe imported from Mexico occurred in the spring of consecutive years during 2000-2002. In each outbreak, the isolates had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns; the PFGE patterns observed in the 2000 and 2002 outbreaks were indistinguishable, but the pattern from 2001 was unique among them. Outbreaks were identified first by the California Department of Health Services (2000 and 2001) and the Washington State Department of Health (2002) and involved residents of 12 states and Canada. This report describes the investigations, which led ultimately to an import alert on cantaloupes from Mexico. To limit the potential for cantaloupe contamination, the Food and Drug Administration (FDA) continues to work with the Mexican government on a food-safety program for the production, packing, and shipping of fresh cantaloupes.     

Increases in fluoroquinolone-resistant Neisseria gonorrhoeae--Hawaii and California, 2001

Neisseria gonorrhoeae is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility, and it can facilitate human immunodeficiency virus (HIV) transmission. Gonorrhea is the second most frequently reported communicable disease in the United States, with 361,705 reported cases in 2001. During the 1980s, gonococcal resistance to penicillin and tetracycline became widespread; as a result, CDC recommended using cephalosporins as first-line treatment for gonorrhea. Since 1993, CDC also has recommended using fluoroquinolones (i.e., ciprofloxacin, ofloxacin, or levofloxacin) for gonorrhea treatment. Fluoroquinolone therapy is used widely because it is a relatively inexpensive, oral, and single-dose therapy. However, fluoroquinolone-resistant N. gonorrhoeae (QRNG) is being identified more frequently. This report summarizes investigations of increases in QRNG in Hawaii and California in 2001 and provides data to support the recommendation that cephalosporins (i.e., ceftriaxone or cefixime) be used instead of fluoroquinolones as first-line treatment for gonorrhea acquired in these two states. The increases in QRNG highlight the importance of monitoring gonococcal resistance throughout the United States to guide local treatment decisions.     

Influenza outbreak--Madagascar,July-August 2002

In mid-July 2002, Madagascar health authorities were notified of a substantial number of deaths attributed to acute respiratory illness (ARI) in the village of Sahafata (population: 2,160), located in the rural highlands of Fianarantsoa Province, southeastern Madagascar (Figure 1). This region is approximately 450 km (280 miles) south of the capital Antananarivo. The Madagascar Ministry of Health (MOH) and the Institut Pasteur, Madagascar (IPM) initiated an investigation, which found an attack rate of 70% for ARI, with 27 deaths in Sahafata. Pharyngeal swab specimens were collected from ill persons for viral culture. Of the four influenza A viruses that were isolated at IPM, two were identified as type A (H3N2) viruses. In late July, health authorities investigated a similar outbreak in Ikongo District, Fianarantsoa Province. In August, MOH requested assistance from the World Health Organization (WHO) and CDC in investigating the outbreak. In response, an international team of experts from CDC; Institut de Veille Sanitaire, France; Institut Pasteur, France; and WHO was mobilized from the Global Outbreak Alert and Response Network; the team arrived in Madagascar on August 14. This report summarizes the preliminary epidemiologic and virologic findings, which suggest that the outbreak was attributable to influenza A (H3N2) viruses. Further surveillance and research about the epidemiology of influenza in Madagascar is planned.     

West Nile Virus activity--United States, 2001

In 2001, West Nile virus (WNV) activity was reported from 359 counties in 27 states and the District of Columbia (DC) to ArboNET, a web-based, surveillance data network maintained by 54 state and local public health agencies and CDC. This activity represented a marked increase from 2000, when WNV activity was reported from 138 counties in 12 states and DC. This report summarizes surveillance data for 2001, which indicate that 66 human illnesses were reported from 10 states and that widespread WNV activity in birds, horses, and mosquitoes extended into the midwestern United States and several southern states unaffected previously. The findings in this report underscore the need for public education, increased WNV surveillance aimed at early viral detection, and sustained, integrated mosquito-control activities.     

Progress toward global eradication of poliomyelitis, 2001

From the initiation of the global poliomyelitis eradication initiative in 1988 through 2001, the number of countries where polio is endemic decreased from 125 to 10, and the number of reported polio cases decreased by >99% from an estimated 350,000 to <1,000. Wild type 2 poliovirus has not been detected worldwide since October 1999. The American and Western Pacific Regions of the World Health Organization (WHO) have been certified free of indigenous wild poliovirus. Current challenges to global polio eradication efforts include ongoing intense transmission in northern India, continued importations of wild poliovirus into polio-free areas, and the detection of circulating vaccine-derived poliovirus (cVDPV). This report summarizes global progress in polio eradication during 2001 and the current status of the initiative.