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Notes from the Field: Hospitalizations for Respiratory Disease Among Unaccompanied Children from Central America — Multiple States, June–July 2014

August 18, 2014 Comments off

Notes from the Field: Hospitalizations for Respiratory Disease Among Unaccompanied Children from Central America — Multiple States, June–July 2014
Source: Morbidity and Mortality Weekly Report (CDC)

During October 2013–June 2014, approximately 54,000 unaccompanied children, mostly from the Central American countries of El Salvador, Guatemala, and Honduras, were identified attempting entry into the United States from Mexico, exceeding numbers reported in previous years (1). Once identified in the United States, U.S. Customs and Border Protection, an agency of the U.S. Department of Homeland Security, processes the unaccompanied children and transfers them to the Office of Refugee Resettlement (ORR), an office of the Administration for Children and Families, U.S. Department of Health and Human Services. ORR cares for the children in shelters until they can be released to a sponsor, typically a parent or relative, who can care for the child while their immigration case is processed. In June 2014, in response to the increased number of unaccompanied children, U.S. Customs and Border Protection expanded operations to accommodate children at a processing center in Nogales, Arizona. ORR, together with the U.S. Department of Defense, opened additional large temporary shelters for the children at Lackland Air Force Base, Texas; U.S. Army Garrison Ft. Sill, Oklahoma; and Naval Base Ventura County, California.

On July 10, 2014, CDC was informed by the California Department of Public Health and ORR about four unaccompanied male children aged 14–16 years with respiratory illnesses at Naval Base Ventura County, three of whom were hospitalized with pneumonia. Among the three patients with pneumonia, two were bacteremic with Streptococcus pneumoniae, ultimately determined to be serotype 5, one of whom also had laboratory-confirmed influenza B virus by polymerase chain reaction (PCR). The fourth patient, without pneumonia, had PCR-confirmed influenza A(H1N1)pdm09. Pneumococcal bacteremia is uncommon among U.S. adolescents, particularly serotype 5, with only three such cases identified in the past 10 years by CDC (2). In addition, influenza activity in the United States is typically lowest in the middle of summer, and Ventura County had no reports of an unusual increase in influenza activity in the community at the time. ORR asked CDC to investigate the scope of this apparent outbreak and implement measures to interrupt transmission.

During July 6–19, 2014, CDC was informed of other clusters of hospitalized children with respiratory disease, increasing the total to 16 cases. The cases were from Naval Base Ventura County (eight cases), Ft. Sill (three), Lackland Air Force Base (two), a standard ORR shelter near Houston, Texas (two), and the Nogales processing center (one). Cases were in persons aged 14–17 years. Diagnoses included laboratory-confirmed pneumococcal pneumonia with laboratory-confirmed influenza (three cases) and without laboratory-confirmed influenza (four cases), influenza pneumonia (one case), and pneumonia with no identified etiology (eight cases). Five patients experienced septic shock requiring intensive care. No case was fatal. All six cases for which pneumococcal isolates were available were identified as serotype 5, a serotype included in 13-valent pneumococcal conjugate vaccine (PCV13) (Prevnar-13, Pfizer). Of the 16 patients identified in this cluster, 11 were tested for influenza viruses; four (36%) were positive (two for influenza A[H1N1]pdm09, one for influenza B, and one for influenza A by rapid test).

Because of the concern that unaccompanied children were at increased risk for influenza and pneumococcal pneumonia in this outbreak setting and the clinically important interaction between influenza and pneumococcal infections (3), CDC recommended that all children residing in temporary or standard ORR shelters receive influenza vaccine and PCV13 in addition to routinely recommended vaccines. Approximately 2,000 children in four affected shelters were vaccinated during July 18–30 with PCV13 and with Food and Drug Administration–approved extended expiration date–specific lots of 2013–14 seasonal influenza vaccine, which includes influenza A(H1N1)pdm09 and influenza B viruses. The shelters reported no serious adverse events.

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Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013

August 3, 2014 Comments off

Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013
Source: Morbidity and Mortality Weekly Report (CDC)

On August 30, 2013, the Florida Department of Health in Columbia County was notified of a Bordetella pertussis laboratory-positive unimmunized child attending a local charter school (316 students from pre-K through 8th grade) in a large religious community averse to health care and vaccinations. Kindergarten immunization records showed that only five (15%) of 34 students were fully immunized with pertussis-antigen–containing vaccines. In seventh grade, only one (5%) of 22 students was fully immunized with pertussis-antigen–containing vaccines. Of the children who were not fully immunized in these two grades, 84% had religious exemptions (1).

Interviews confirmed that a sibling of the patient had symptoms consistent with pertussis. By September 3, two additional children from the same school were confirmed by polymerase chain reaction to have pertussis. On September 12, the Florida Department of Health in Columbia County declared a communicable disease emergency; children with cough illness were excluded from school, and reentry required an evaluation by a health care provider. After this declaration, 38 additional students were excluded. Prophylaxis or treatment with antibiotics following current guidelines were provided to patients and household contacts (2). The local health department offered to provide these services free of charge to persons without health care coverage. Pertussis vaccine administered at the health department was available; however, fewer than five persons from the community used this opportunity for vaccination.

Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis

July 14, 2014 Comments off

Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis
Source: Environmental Health Perspectives

Background:
Particulate matter (PM) in outdoor air pollution was recently designated a Group I carcinogen by the International Agency for Research on Cancer (IARC). This determination was based on the evidence regarding the relationship of PM2.5 and PM10 to lung cancer risk; however, the IARC evaluation did not include a quantitative summary of the evidence.

Objective:
To provide a systematic review and quantitative summary of the evidence regarding the relationship between PM and lung cancer.

Methods:
We conducted meta-analyses of studies examining the relationship of exposure to PM2.5 and PM10 with lung cancer incidence and mortality. In total, 18 studies met inclusion criteria and provided the information necessary to estimate the change in lung cancer risk per 10-μg/m3 increase in exposure to PM. We used random effects analyses to allow between study variability to contribute to meta-estimates.

Results:
The meta-relative risk (95% CI) for lung cancer associated with PM2.5 was 1.09 (95% CI: 1.04, 1.14). The meta-relative risk of lung cancer associated with PM10 was similar, but less precise: 1.08 (95% CI: 1.00, 1.17). Estimates were robust to restriction to studies that considered potential confounders, as well as sub-analyses by exposure assessment method. Analyses by smoking status showed that lung cancer risk associated with PM2.5 was greatest for former smokers, 1.44 (95% CI: 1.04, 1.22) followed by never smokers, 1.18 (95% CI: 1.00, 1.39), and then current smokers, 1.06 (95% CI: 0.97, 1.15). In addition, meta-estimates for adenocarcinoma associated with PM2.5 and PM10 were 1.40 (95% CI: 1.07, 1.83) and 1.29 (95% CI: 1.02, 1.63), respectively.

Conclusion:
The results of these analyses, and the decision of the IARC working group to classify PM and outdoor air pollution as carcinogenic (Group 1), further justify efforts to reduce exposures to air pollutants that can arise from many sources.

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits

June 28, 2014 Comments off

State-Based Medicaid Costs for Pediatric Asthma Emergency Department Visits
Source: Preventing Chronic Disease (CDC)

Introduction
The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.

Methods
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children’s Health Insurance Program) was the primary payer.

Results
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.

Conclusions
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.

CDC Travel Notice — MERS in the Arabian Peninsula

May 30, 2014 Comments off

MERS in the Arabian Peninsula
Source: Centers for Disease Control and Prevention

Cases of MERS (Middle East Respiratory Syndrome) have been identified in multiple countries in the Arabian Peninsula. There have also been cases in several other countries in travelers who have been to the Arabian Peninsula and, in some instances, their close contacts. Two cases have been confirmed in two health care workers living in Saudi Arabia who were visiting the United States.

CDC does not recommend that travelers change their plans because of MERS. Most instances of person-to-person spread have occurred in health care workers and other close contacts (such as family members and caregivers) of people sick with MERS. If you are concerned about MERS, you should discuss your travel plans with your doctor.

Reducing black carbon emissions from diesel vehicles : impacts, control strategies, and cost-benefit analysis

May 23, 2014 Comments off

Reducing black carbon emissions from diesel vehicles : impacts, control strategies, and cost-benefit analysis
Source: World Bank

A 2013 scientific assessment of black carbon emissions and impacts found that black carbon is second to carbon dioxide in terms of its climate forcing. High concentrations of black carbon in the atmosphere can change precipitation patterns and reduce the amount of radiation that reaches the Earth’s surface, which affects local agriculture. Acute and chronic exposures to particulate matter are associated with a range of diseases, including chronic bronchitis and asthma, as well as premature deaths from cardiopulmonary disease, lung cancer, and acute lower respiratory infections. The transportation sector accounted for approximately 19 percent of global black carbon emissions in the year 2000. This report aims to inform efforts to control black carbon emissions from diesel-based transportation in developing countries. It presents a summary of emissions control approaches from developed countries, while recognizing that developing countries face a number of on-the-ground implementation challenges. This study applies a new cost-benefit analysis methodology to four simulated diesel black carbon emissions control projects – diesel retrofit in Istanbul, green freight (plus retrofit) in Sao Paulo, fuel and vehicle standards in Jakarta, and compressed natural gas (CNG) buses in Cebu taking into account the additional climate benefits of black carbon reductions. While this report focuses on quantifying just the health and climate benefits of transport interventions, it also serves to highlight the challenges that can be faced when undertaking more comprehensive evaluation of transport projects. A cost-benefit framework for economic analysis of diesel black carbon emissions control transport projects is also presented that factors in both climate and health benefits. Historically, technical interventions to control diesel black carbon emissions in developed countries have successfully relied on fuel quality improvements and vehicle emissions standards.

The Cost of Air Pollution: Health Impacts of Road Transport

May 22, 2014 Comments off

The Cost of Air Pollution: Health Impacts of Road Transport
Source: Organisation for Economic Co-operation and Development

Outdoor air pollution kills more than 3 million people across the world every year, and causes health problems from asthma to heart disease for many more. This is costing societies very large amounts in terms of the value of lives lost and ill health. Based on extensive new epidemiological evidence since the 2010 Global Burden of Disease study, and OECD estimates of the Value of Statistical Life, this report provides evidence on the health impacts from air pollution and the related economic costs.

CDC — Middle East Respiratory Syndrome (MERS)

May 12, 2014 Comments off

Middle East Respiratory Syndrome (MERS)
Source: Centers for Disease Control and Prevention

Middle East Respiratory Syndrome (MERS) is viral respiratory illness first reported in Saudi Arabia in 2012. It is caused by a coronavirus called MERS-CoV. Most people who have been confirmed to have MERS-CoV infection developed severe acute respiratory illness. They had fever, cough, and shortness of breath. More than 30% of these people died.

So far, all the cases have been linked to countries in the Arabian Peninsula. This virus has spread from ill people to others through close contact, such as caring for or living with an infected person. However, there is no evidence of sustained spreading in community settings.

On May 2, 2014, the first U.S. case of MERS was confirmed in a traveler from Saudi Arabia to the U.S. The traveler is considered to be fully recovered and has been released from the hospital. Public health officials have contacted healthcare workers, family members, and travelers who had close contact with the patient. At this time, none of these contacts has had evidence of being infected with MERS-CoV.

On May 11, 2014, a second U.S. imported case of MERS was confirmed in a traveler who also came to the U.S. from Saudi Arabia. This patient is currently hospitalized and doing well. People who had close contact with this patient are being contacted. The two U.S. cases are not linked.

Potentially Preventable Deaths from the Five Leading Causes of Death — United States, 2008–2010

May 12, 2014 Comments off

Potentially Preventable Deaths from the Five Leading Causes of Death — United States, 2008–2010
Source: Morbidity and Mortality Weekly Report (CDC)

In 2010, the top five causes of death in the United States were 1) diseases of the heart, 2) cancer, 3) chronic lower respiratory diseases, 4) cerebrovascular diseases (stroke), and 5) unintentional injuries (1). The rates of death from each cause vary greatly across the 50 states and the District of Columbia (2). An understanding of state differences in death rates for the leading causes might help state health officials establish disease prevention goals, priorities, and strategies. States with lower death rates can be used as benchmarks for setting achievable goals and calculating the number of deaths that might be prevented in states with higher rates. To determine the number of premature annual deaths for the five leading causes of death that potentially could be prevented (“potentially preventable deaths”), CDC analyzed National Vital Statistics System mortality data from 2008–2010. The number of annual potentially preventable deaths per state before age 80 years was determined by comparing the number of expected deaths (based on average death rates for the three states with the lowest rates for each cause) with the number of observed deaths. The results of this analysis indicate that, when considered separately, 91,757 deaths from diseases of the heart, 84,443 from cancer, 28,831 from chronic lower respiratory diseases, 16,973 from cerebrovascular diseases (stroke), and 36,836 from unintentional injuries potentially could be prevented each year. In addition, states in the Southeast had the highest number of potentially preventable deaths for each of the five leading causes. The findings provide disease-specific targets that states can use to measure their progress in preventing the leading causes of deaths in their populations.

Spotlight on Senior Health: Adverse Health Outcomes of Food Insecure Older Americans

April 28, 2014 Comments off

Spotlight on Senior Health: Adverse Health Outcomes of Food Insecure Older Americans
Source: Feeding America

The Spotlight on Senior Health: Adverse Health Outcomes of Food Insecure Older Americans research study documents the health and nutrition implications of food insecurity among seniors aged 60 and older. The study reveals that senior food insecurity is associated with lower nutrient intake and an increased risk for chronic health conditions.

Compared to food secure seniors, food insecure seniors are:

  • 60 percent more likely to experience depression
  • 53 percent more likely to report a heart attack
  • 52 percent more likely to develop asthma
  • 40 percent more likely to report an experience of congestive heart failure

In addition, Spotlight on Senior Health highlights that the senior population is particularly vulnerable to the negative health and nutrition implications of food insecurity compared to other adult age groups.

Trends in Tuberculosis — United States, 2013

March 25, 2014 Comments off

Trends in Tuberculosis — United States, 2013
Source: Morbidity and Mortality Weekly Report (PDF)

In 2013, a total of 9,588 new tuberculosis (TB) cases were reported in the United States, with an incidence rate of 3.0 cases per 100,000 population, a decrease of 4.2% from 2012 (1). This report summarizes provisional TB surveillance data reported to CDC in 2013. Although case counts and incidence rates continue to decline, certain populations are disproportionately affected. The TB incidence rate among foreign-born persons in 2013 was approximately 13 times greater than the incidence rate among U.S.-born persons, and the proportion of TB cases occurring in foreign-born persons continues to increase, reaching 64.6% in 2013. Racial/ethnic disparities in TB incidence persist, with TB rates among non-Hispanic Asians almost 26 times greater than among non-Hispanic whites. Four states (California, Texas, New York, and Florida), home to approximately one third of the U.S. population, accounted for approximately half the TB cases reported in 2013. The proportion of TB cases occurring in these four states increased from 49.9% in 2012 to 51.3% in 2013. Continued progress toward TB elimination in the United States will require focused TB control efforts among populations and in geographic areas with disproportionate burdens of TB.

See also: Implementation of New TB Screening Requirements for U.S.-Bound Immigrants and Refugees — 2007–2014

Trends in Pediatric and Adult Hospital Stays for Asthma, 2000-2010

March 17, 2014 Comments off

Trends in Pediatric and Adult Hospital Stays for Asthma, 2000-2010
Source: Agency for Healthcare Research and Quality

Asthma is a chronic disease characterized by inflammation of the airways. It restricts the passage of air into the lungs and leads to episodes of wheezing, coughing, chest tightness, and shortness of breath. Severe asthmatic episodes can close off airways completely and, in some cases, may be life-threatening.1

In 2010, approximately 7.0 million children aged 0—17 years and 18.7 million adults aged 18 years and older had a diagnosis of asthma. The prevalence of asthma in the United States has increased from 7.3 percent of the population in 2001 to 8.4 percent in 2010.2

Asthma is largely controllable with proper primary care, and the need for hospitalization can usually be prevented. However, differences in rates of hospitalization for asthma suggest that there is significant room for improvement in caring for the condition.

This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on trends in pediatric and adult inpatient hospital stays for asthma at U.S. community hospitals from 2000 through 2010. In addition, we present patient characteristics of pediatric and adult hospital stays for asthma in 2010. Differences that are noted in the text exhibit at least a 10 percent difference between estimates and are statistically significant at 0.05 or better.

Lung Cancer Incidence Trends Among Men and Women — United States, 2005–2009

January 14, 2014 Comments off

Lung Cancer Incidence Trends Among Men and Women — United States, 2005–2009
Source: Morbidity and Mortality Weekly Report (CDC)

Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer (excluding skin cancer) among men and women in the United States (1,2). Although lung cancer can be caused by environmental exposures, most efforts to prevent lung cancer emphasize tobacco control because 80%–90% of lung cancers are attributed to cigarette smoking and secondhand smoke (1). One sentinel health consequence of tobacco use is lung cancer (1,2), and one way to measure the impact of tobacco control is by examining trends in lung cancer incidence rates, particularly among younger adults (3). Changes in lung cancer rates among younger adults likely reflect recent changes in risk exposure (3). To assess lung cancer incidence and trends among men and women by age group, CDC used data from the National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program for the period 2005–2009, the most recent data available. During the study period, lung cancer incidence decreased among men in all age groups except <35 years and decreased among women aged 35–44 years and 54–64 years. Lung cancer incidence decreased more rapidly among men than among women and more rapidly among adults aged 35–44 years than among other age groups. To further reduce lung cancer incidence in the United States, proven population-based tobacco prevention and control strategies should receive sustained attention and support (4).

Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial

November 5, 2013 Comments off

Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial
Source: British Medical Journal

Objective
To assess strategies for advice on analgesia and steam inhalation for respiratory tract infections.

Design
Open pragmatic parallel group factorial randomised controlled trial.

Setting
Primary care in United Kingdom.

Participants
Patients aged ≥3 with acute respiratory tract infections.

Intervention
889 patients were randomised with computer generated random numbers in pre-prepared sealed numbered envelopes to components of advice or comparator advice: advice on analgesia (take paracetamol, ibuprofen, or both), dosing of analgesia (take as required v regularly), and steam inhalation (no inhalation v steam inhalation).

Outcomes
Primary: mean symptom severity on days 2-4; symptoms rated 0 (no problem) to 7 (as bad as it can be). Secondary: temperature, antibiotic use, reconsultations.

Results
Neither advice on dosing nor on steam inhalation was significantly associated with changes in outcomes. Compared with paracetamol, symptom severity was little different with ibuprofen (adjusted difference 0.04, 95% confidence interval −0.11 to 0.19) or the combination of ibuprofen and paracetamol (0.11, −0.04 to 0.26). There was no evidence for selective benefit with ibuprofen among most subgroups defined before analysis (presence of otalgia; previous duration of symptoms; temperature >37.5°C; severe symptoms), but there was evidence of reduced symptoms severity benefit in the subgroup with chest infections (ibuprofen −0.40, −0.78 to −0.01; combination −0.47; −0.84 to −0.10), equivalent to almost one in two symptoms rated as a slight rather than a moderately bad problem. Children might also benefit from treatment with ibuprofen (ibuprofen: −0.47, −0.76 to −0.18; combination: −0.04, −0.31 to 0.23). Reconsultations with new/unresolved symptoms or complications were documented in 12% of those advised to take paracetamol, 20% of those advised to take ibuprofen (adjusted risk ratio 1.67, 1.12 to 2.38), and 17% of those advised to take the combination (1.49, 0.98 to 2.18). Mild thermal injury with steam was documented for four patients (2%) who returned full diaries, but no reconsultations with scalding were documented.

Conclusion
Overall advice to use steam inhalation, or ibuprofen rather than paracetamol, does not help control symptoms in patients with acute respiratory tract infections and must be balanced against the possible progression of symptoms during the next month for a minority of patients. Advice to use ibuprofen might help short term control of symptoms in those with chest infections and in children.

CRS — The President’s Emergency Plan for AIDS Relief (PEPFAR), U.S. Global HIV/AIDS, Tuberculosis, and Malaria Programs: A Description of Permanent and Expiring Authorities

October 1, 2013 Comments off

The President’s Emergency Plan for AIDS Relief (PEPFAR), U.S. Global HIV/AIDS, Tuberculosis, and Malaria Programs: A Description of Permanent and Expiring Authorities (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Fighting HIV/AIDS, tuberculosis (TB), and malaria globally is a priority for Congress. The 108th and 110th Congresses enacted two pieces of legislation that have shaped U.S. responses to these diseases: P.L. 108-25, the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Leadership Act), and P.L. 110-293, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Lantos-Hyde Act). The Leadership Act authorized $15 billion to be spent from FY2004 through FY2008 on fighting HIV/AIDS, TB, and malaria. The Lantos-Hyde Act amended the Leadership Act to authorize $48 billion for fighting the three diseases from FY2009 through FY2013.

The Leadership Act (and the legislation that it amends) is the primary vehicle through which U.S. global assistance for fighting these diseases is authorized. The Lantos-Hyde Act mostly amends the Leadership Act, though it amends some other acts, such as the Foreign Assistance Act of 1961, and includes some stand-alone authorities. The Leadership Act and the Lantos-Hyde Act (primarily through amendments to the Leadership Act) created frameworks for how the funds should be spent, established program goals and targets, and established coordinating offices for managing government-wide responses.

The Leadership Act required the President to establish the Coordinator of the United States Government Activities to Combat HIV/AIDS Globally (known as the Global AIDS Coordinator) at the Department of State. Congress appropriates the bulk of global HIV/AIDS funds to the Office of the Global AIDS Coordinator, which leads the President’s Emergency Plan for AIDS Relief (PEPFAR). The Global AIDS Coordinator distributes the majority of these funds to U.S. federal agencies and departments and multilateral groups like the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Lantos-Hyde Act amended the Leadership Act to establish the Coordinator of the United States Government Activities to Combat Malaria Globally (known as the Malaria Coordinator) at the U.S. Agency for International Development (USAID) to oversee implementation of related efforts by USAID and the Centers for Disease Control and Prevention. Some authorities within these Acts are enduring, such as those that created the Global AIDS and Malaria Coordinator positions (Leadership Act, as amended) and permitted U.S. participation in advance market commitments for vaccine development (Lantos-Hyde Act). Other authorities, however, are set to expire, such as language authorizing funding for global HIV/AIDS, TB, and malaria programs.

This report explains which authorities within the Leadership and Lantos-Hyde Acts are set to expire and which are permanent. Table A-1 in the Appendix A offers a side-by-side comparison of the Leadership Act in its original form and the Lantos-Hyde Act, which amends the Leadership Act and other legislation. A third column explains which sections are set to expire and summarizes language in S. 1545 and H.R. 3177 that amend the Leadership Act, as amended. The Leadership Act, as amended and Lantos-Hyde Act include comprehensive reporting requirements. Table A-2 in the Appendix A lists the reporting requirements and describes the extent to which the Administration has complied with the requirements.

Rather than revisit some of the contentious issues that dominated debate when crafting the Lantos-Hyde Act, House and Senate Members introduced legislation (H.R. 3177 and S. 1545) that is narrowly aimed at key priorities: enhancing oversight of U.S. global HIV/AIDS, TB, and malaria programs; authorizing appropriations for the Global Fund through FY2018; and allocating a portion of HIV/AIDS funds for orphans and vulnerable children (OVC) and for HIV/AIDS treatment and care. Table B-1 in Appendix B summarizes key amendments in the bills, entitled the PEPFAR Stewardship and Oversight Act.

CRS — Clean Air Issues in the 113th Congress: An Overview

July 25, 2013 Comments off

Clean Air Issues in the 113th Congress: An Overview (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

As the 113th Congress continues consideration of air quality issues, oversight of Environmental Protection Agency (EPA) regulatory actions is expected to remain the main focus. Of particular interest are EPA’s Clean Air Act regulations on emissions of greenhouse gases and revision of the ambient air quality standards for ozone. President Obama’s June 25 announcement of initiatives to address climate change has sparked renewed interest in the former, and EPA’s expected proposal of new ozone standards by the end of the year is stimulating interest in the latter.

Air quality has improved substantially in the United States in the 40 years of EPA’s Clean Air Act (CAA) regulation. According to the agency’s science advisers and others, however, more needs to be done to protect public health and the environment from the effects of air pollution. Thus, the agency continues to promulgate regulations using authority given it by Congress in CAA amendments more than 20 years ago. Members of Congress from both parties have raised questions about the cost-effectiveness of some of these regulations and/or whether the agency has exceeded statutory authority in promulgating them. Others in Congress have supported EPA, noting that the Clean Air Act, often affirmed in court decisions, has authorized or required the agency’s actions. EPA’s regulatory actions on greenhouse gas (GHG) emissions have been one focus of congressional interest. Although the Obama Administration has consistently said that it would prefer that Congress pass new legislation to address climate change, such legislation now appears unlikely. Instead, over the last four years, EPA has developed GHG emission standards using its existing CAA authority. Relying on a finding that GHGs endanger public health and welfare, the agency promulgated GHG emission standards for cars and light trucks on May 7, 2010, and again on October 15, 2012, and for larger trucks on September 15, 2011. The implementation of these standards, in turn, triggered permitting and Best Available Control Technology requirements for new major stationary sources of GHGs (power plants, manufacturing facilities, etc.).

It is the triggering of standards for stationary sources that has raised the most concern in Congress. A proposal to limit carbon dioxide emissions from new power plants is the focus of attention currently, but other sources (refineries, cement plants, etc.) could be subject to GHG emission controls under the same statutory authority. Also, on June 25, the President directed EPA to develop standards for existing power plants by June 2015. Legislation has been considered in both the House and Senate aimed at preventing EPA from implementing such requirements. The House passed several of these bills in the 112th Congress, but none of them passed the Senate.

Besides addressing climate change, EPA has taken action on a number of other air pollution regulations, generally in response to court actions remanding previous rules. Remanded rules included the Clean Air Interstate Rule (CAIR) and the Clean Air Mercury Rule—rules designed to control the long-range transport of sulfur dioxide, nitrogen oxides, and mercury from power plants through cap-and-trade programs. Other remanded rules included hazardous air pollutant standards for boilers and cement kilns. EPA also recently proposed a controversial rule to lower the sulfur content of gasoline, in conjunction with tighter (“Tier3”) standards for motor vehicle emissions.

In addition to these rules, EPA is reviewing ambient air quality standards (NAAQS) for ozone and other widespread air pollutants. An ozone NAAQS proposal is expected by the end of 2013. NAAQS serve as EPA’s definition of clean air, and drive a range of regulatory controls. EPA’s review process for the NAAQS, mandated at five-year intervals by the Clean Air Act, has also faced opposition in Congress. As passed by the House in the 112th Congress, H.R. 2401 and H.R. 3409 would have amended the act to require EPA to consider feasibility and cost in setting NAAQS, reversing a unanimous 2001 Supreme Court decision that the law requires standards based on health considerations alone.

Global premature mortality due to anthropogenic outdoor air pollution and the contribution of past climate change

July 16, 2013 Comments off

Global premature mortality due to anthropogenic outdoor air pollution and the contribution of past climate change
Source: Environmental Research Letters

Increased concentrations of ozone and fine particulate matter (PM2.5) since preindustrial times reflect increased emissions, but also contributions of past climate change. Here we use modeled concentrations from an ensemble of chemistry–climate models to estimate the global burden of anthropogenic outdoor air pollution on present-day premature human mortality, and the component of that burden attributable to past climate change. Using simulated concentrations for 2000 and 1850 and concentration–response functions (CRFs), we estimate that, at present, 470 000 (95% confidence interval, 140 000 to 900 000) premature respiratory deaths are associated globally and annually with anthropogenic ozone, and 2.1 (1.3 to 3.0) million deaths with anthropogenic PM2.5-related cardiopulmonary diseases (93%) and lung cancer (7%). These estimates are smaller than ones from previous studies because we use modeled 1850 air pollution rather than a counterfactual low concentration, and because of different emissions. Uncertainty in CRFs contributes more to overall uncertainty than the spread of model results. Mortality attributed to the effects of past climate change on air quality is considerably smaller than the global burden: 1500 (−20 000 to 27 000) deaths yr−1 due to ozone and 2200 (−350 000 to 140 000) due to PM2.5. The small multi-model means are coincidental, as there are larger ranges of results for individual models, reflected in the large uncertainties, with some models suggesting that past climate change has reduced air pollution mortality.

Update: Recommendations for Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

July 11, 2013 Comments off

Update: Recommendations for Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Source: Morbidity and Mortality Weekly Report (CDC)

On June 11, 2013, CDC issued interim infection prevention and control recommendations for hospitalized patients with known or suspected Middle East respiratory syndrome coronavirus (MERS-CoV) infection in U.S. hospitals (1). To date, no MERS-CoV cases have been reported in the United States; however, cases have been reported in eight other countries (2). Recent published reports (3,4) have described limited health-care transmission of MERS-CoV, including cases among health-care personnel in international settings. These published reports highlight the need for rapid detection of infectious patients and adherence to correct infection prevention measures to prevent transmission of the virus among patients, health-care personnel, and visitors.

In coming months, the U.S. health-care system might be called upon to provide care to patients infected with MERS-CoV. Front-line providers and health-care organizations should be prepared to care for MERS-CoV patients as part of routine operations. To aid providers and facilities, CDC has developed checklists that identify key actions that can be taken now to enhance preparedness for treating persons with MERS-CoV infection and compiled a list of preparedness resources (available at http://www.cdc.gov/coronavirus/mers/preparedness).

Additional information, including guidance on case definitions, infection control, case investigation, and specimen collection and testing, is available at the CDC MERS website (2). The MERS website contains the most current information and guidance, which is subject to change. State and local health departments with questions should contact the CDC Emergency Operations Center at telephone, 770-488-7100.

Asthma and Complementary Health Approaches

July 8, 2013 Comments off

Asthma and Complementary Health Approaches
Source: National Center for Complementary and Alternative Medicine (NCCAM)

Asthma is a chronic lung disease that affects people of all ages. It causes episodes of wheezing, coughing, shortness of breath, and chest tightness. Although there is no cure, most people with asthma are able to manage the disease with medications and behavioral changes.

Researchers also are studying various complementary health approaches for asthma relief. This fact sheet provides basic information about asthma, summarizes scientific research on the effectiveness and safety of complementary health approaches for asthma, and suggests sources for additional information.

CRS — U.S. Global Health Assistance: Background and Issues for the 113th Congress

July 5, 2013 Comments off

U.S. Global Health Assistance: Background and Issues for the 113th Congress (PDF)
Source: Congressional Research Service (via U.S. Department of State Foreign Press Center)

Congressional support for global health programs has been increasing, particularly during the George W. Bush Administration. Combined global health funding from State-Foreign Operations, Labor-HHS and Defense appropriations rose from $1.7 billion in FY2001 to $8.9 billion in FY2012. The FY2013 Consolidated Appropriations Ac t (P.L. 113-6) includes approximately $8.4 billion for global health programs funded through State-Foreign Operations appropriations, up from $8.2 billion in FY2012. (FY2013 funding levels will likely change, however, due to sequestration.) These funds support global health programs implemented and managed by the U.S. Agency for International Development (USA ID), State Department and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)—a multilateral organization aimed at fighting HIV/AIDS, TB, and malaria worldwide. The act does not specify how much should be spent on global health programs through other appropriations.

Concern about infectious diseases, especially HIV/AIDS, has driven much of the budgetary increases. Excluding funding for the Global Fund, roughly 34% of the FY2001 U.S. global health budget was aimed at programs that address HIV/ AIDS. By 2012, about 57% of U.S. global health spending was aimed at fighting HIV/AIDS worldwide, and the FY2014 budget request calls for nearly 54% of global health spending to be aimed at the disease.

In the 112 th Congress, concerns about the strength of the U.S. economy and federal spending precipitated discussions about the role and effica cy of U.S. foreign aid, including global health programs. Critics began to push for U.S. global health programs to demonstrate impact and improve cost-efficiency. At the same time, supporters underscored the advances U.S. global health programs had made, the millions of lives saved in part with U.S. resources, and the promise of innovative health solutions. It is likely that this debate will continue in the 113 th Congress. Other issues the 113 th Congress may face include

  • deliberating funding levels for U.S. global health programs;
  • examining U.S. leadership of U.S. global health programs;
  • maintaining global HIV/AIDS commitments;
  • deliberating the reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR) in FY2013; and
  • determining the appropriate mix of multilateral and bilateral spending for global HIV/AIDS, TB, and malaria programs.
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