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CDC — 2014 Ebola Outbreak: Information and Updates

September 24, 2014 Comments off

2014 Ebola Outbreak: Information and Updates
Source: Centers for Disease Control and Prevention

The 2014 Ebola outbreak is the largest Ebola outbreak in history and the first Ebola outbreak in West Africa. This outbreak is the first Ebola epidemic the world has ever known — affecting multiple countries in West Africa. Although the risk of an Ebola outbreak in the United States is very low, CDC and partners are taking precautions to prevent this from happening.

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Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

September 23, 2014 Comments off

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Source: Morbidity and Mortality Weekly Report (CDC)

A single dose of PPSV23 is recommended for routine use in the United States among adults aged ≥65 years. Effectiveness of PPSV23 in preventing IPD in adults has been demonstrated, but the data on the effectiveness of this vaccine in preventing noninvasive pneumococcal pneumonia among adults aged ≥65 years have been inconsistent. PPSV23 contains 12 serotypes in common with PCV13 and 11 additional serotypes. In 2013, 38% of IPD among adults aged ≥65 years was caused by serotypes unique to PPSV23. Given the high proportion of IPD caused by serotypes unique to PPSV23, broader protection is expected to be provided through use of both PCV13 and PPSV23 in series. ACIP considered multiple factors when determining the optimal interval between a dose of PCV13 and PPSV23, including immune response, safety, the risk window for protection against disease caused by serotypes unique to PPSV23, as well as timing for the next visit to the vaccination provider.

Prenatal Breastfeeding Counseling — Pregnancy Risk Assessment Monitoring System, United States, 2010

September 17, 2014 Comments off

Prenatal Breastfeeding Counseling — Pregnancy Risk Assessment Monitoring System, United States, 2010
Source: Morbidity and Mortality Weekly Report (CDC)

Breastfeeding is a highly effective preventive measure a mother can take after birth to protect the health of her infant, as well as her own. Immunologic and antiinflammatory properties of breast milk protect against numerous illnesses and diseases in children (1). Benefits of breastfeeding for infants include a lower risk for ear infections (2), atopic dermatitis (3), lower respiratory tract infections (4), sudden infant death syndrome (SIDS) (2,5), necrotizing enterocolitis (NEC) in preterm infants (2), type 2 diabetes (6), asthma (7), and childhood obesity (8–10). For mothers, benefits of breastfeeding include a lower risk for breast cancer (11–13) and ovarian cancer (2). Increasing rates of breastfeeding and therefore its health benefits might lower health-care costs. A recent study found that if higher rates of mothers complied with medical recommendations for breastfeeding, an estimated $2.2 billion in additional direct medical costs would be saved annually in the United States (14).

The American Academy of Pediatrics (AAP) stated in its 2012 policy statement on breastfeeding that exclusive breastfeeding for the first 6 months of life is sufficient to support optimal growth and development and recommended that breastfeeding be continued for at least the first year of life and beyond (15). In 2010, the Joint Commission included exclusive breastfeeding during the newborn’s entire hospitalization as part of a set of five nationally implemented measures that address perinatal care, endorsed by the National Quality Forum (NQF #0480) (16). Within the last decade, breastfeeding rates have been increasing; however, despite overall improvements, rates for breastfeeding duration remain relatively low, with only 49.4% of U.S. infants breastfed to any extent at age 6 months and only 18.8% of children exclusively breastfed through the recommended age of 6 months (17). Healthy People 2020 national breastfeeding objectives are to increase the proportion of infants who are ever breastfed to 81.9%, who are breastfed to any extent at 6 months to 60.6% and at 1 year to 34.1%, and who are exclusively breastfed through 3 months to 46.2% and through 6 months to 25.5% (objectives MICH-21.1, 21.2, 21.3, 21.4 and 21.5) (18).

National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2013

September 16, 2014 Comments off

National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2013
Source: Morbidity and Mortality Weekly Report (CDC)

In the United States, among children born during 1994–2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths during their lifetimes (1). Since 1994, the National Immunization Survey (NIS) has monitored vaccination coverage among children aged 19–35 months in the United States. This report describes national, regional, state, and selected local area vaccination coverage estimates for children born January 2010–May 2012, based on results from the 2013 NIS. In 2013, vaccination coverage achieved the 90% national Healthy People 2020 target* for ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.9%); ≥3 doses of hepatitis B vaccine (HepB) (90.8%); ≥3 doses of poliovirus vaccine (92.7%); and ≥1 dose of varicella vaccine (91.2%). Coverage was below the Healthy People 2020 targets for ≥4 doses of diphtheria, tetanus, and pertussis vaccine (DTaP) (83.1%; target 90%); ≥4 doses of pneumococcal conjugate vaccine (PCV) (82.0%; target 90%); the full series of Haemophilus influenzae type b vaccine (Hib) (82.0%; target 90%); ≥2 doses of hepatitis A vaccine (HepA) (54.7%; target 85%); rotavirus vaccine (72.6%; target 80%); and the HepB birth dose (74.2%; target 85%).† Coverage remained stable relative to 2012 for all of the vaccinations with Healthy People 2020 objectives except for increases in the HepB birth dose (by 2.6 percentage points) and rotavirus vaccination (by 4.0 percentage points). The percentage of children who received no vaccinations remained below 1.0% (0.7%). Children living below the federal poverty level had lower vaccination coverage compared with children living at or above the poverty level for many vaccines, with the largest disparities for ≥4 doses of DTaP (by 8.2 percentage points), full series of Hib (by 9.5 percentage points), ≥4 doses of PCV (by 11.6 percentage points), and rotavirus (by 12.6 percentage points). MMR coverage was below 90% for 17 states. Reaching and maintaining high coverage across states and socioeconomic groups is needed to prevent resurgence of vaccine-preventable diseases.

Vital Signs: Sodium Intake Among U.S. School-Aged Children — 2009–2010

September 12, 2014 Comments off

Vital Signs: Sodium Intake Among U.S. School-Aged Children — 2009–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts.
Methods: Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010.

Results:
U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%).

Implications for Public Health Practice:
Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals.

Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization — National Intimate Partner and Sexual Violence Survey, United States, 2011

September 11, 2014 Comments off

Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization — National Intimate Partner and Sexual Violence Survey, United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

Sexual violence, stalking, and intimate partner violence are public health problems known to have a negative impact on millions of persons in the United States each year, not only by way of immediate harm but also through negative long-term health impacts. Before implementation of the National Intimate Partner and Sexual Violence Survey (NISVS) in 2010, the most recent detailed national data on the public health burden from these forms of violence were obtained from the National Violence against Women Survey conducted during 1995–1996.

This report examines sexual violence, stalking, and intimate partner violence victimization using data from 2011. The report describes the overall prevalence of sexual violence, stalking, and intimate partner violence victimization; racial/ethnic variation in prevalence; how types of perpetrators vary by violence type; and the age at which victimization typically begins. For intimate partner violence, the report also examines a range of negative impacts experienced as a result of victimization, including the need for services.

Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014

September 11, 2014 Comments off

Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014
Source: Morbidity and Mortality Weekly Report (CDC)

On August 19, 2014, CDC was notified by Children’s Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5–19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68* (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.

Of the 19 patients from Kansas City in whom EV-D68 was confirmed, 10 (53%) were male, and ages ranged from 6 weeks to 16 years (median = 4 years). Thirteen patients (68%) had a previous history of asthma or wheezing, and six patients (32%) had no underlying respiratory illness. All patients had difficulty breathing and hypoxemia, and four (21%) also had wheezing. Notably, only five patients (26%) were febrile. All patients were admitted to the pediatric intensive care unit, and four required bilevel positive airway pressure ventilation. Chest radiographs showed perihilar infiltrates, often with atelectasis. Neither chest radiographs nor blood cultures were consistent with bacterial coinfection.

Of the 11 patients from Chicago in whom EV-D68 was confirmed, nine patients were female, and ages ranged from 20 months to 15 years (median = 5 years). Eight patients (73%) had a previous history of asthma or wheezing. Notably, only two patients (18%) were febrile. Ten patients were admitted to the pediatric intensive care unit for respiratory distress; two required mechanical ventilation (one of whom also received extracorporeal membrane oxygenation), and two required bilevel positive airway pressure ventilation.

Enteroviruses are associated with various clinical symptoms, including mild respiratory illness, febrile rash illness, and neurologic illness, such as aseptic meningitis and encephalitis. EV-D68, however, primarily causes respiratory illness (1), although the full spectrum of disease remains unclear.

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