U.S. AND 26 OTHER NATIONS COMMIT TO GLOBAL HEALTH SECURITY AGENDA GOALS

FROM:  U.S. HEALTH AND HUMAN SERVICES DEPARTMENT 
Nations Commit to Accelerating Progress against Infectious Disease Threats

The United States joins 26 countries, the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE), to accelerate progress toward a world safe and secure from the threat of infectious disease, and committing to the goals of the Global Health Security Agenda.

“Global health security is a shared responsibility; no one country can achieve it alone,” Health and Human Services Secretary Kathleen Sebelius said. “In the coming months, we will welcome other nations to join the United States and the 26 other countries gathered here in Washington and in Geneva, as we work to close the gaps in our ability to prevent, detect, and respond to infectious disease threats.”

Over the next five years the United States plans to work with at least 30 partner countries (containing at least 4 billion people) to prevent, detect and effectively respond to infectious disease threats, whether naturally occurring or caused by accidental or intentional releases of dangerous pathogens.

“While we have made great progress in fighting and treating diseases, biological threats can emerge anywhere, travel quickly, and take lives,” said Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism.  “The recent outbreaks of H7N9 influenza and Middle East Respiratory Syndrome are reminders of the need to step up our efforts as a global community.  The Global Health Security Agenda is about accelerating progress toward a world safe and secure from infectious disease threats.”

Later this year, the White House will host an event bringing together nations who are committed to protecting the world from infectious disease threats to review progress and chart the way forward on building a global system for preventing, detecting, and responding to such threats.

“The United States and the world can and must do more to prevent, detect, and respond to outbreaks as early and as effectively as possible,” CDC Director Dr. Tom Frieden said.  “CDC conducted two global health security demonstration projects last year in partnership with Vietnam and Uganda to strengthen laboratory systems, develop strong public health emergency operations centers, and create real-time data sharing in health emergencies.  CDC is committed to replicate the successes in these two projects in ten additional countries this year.”

In FY 2014, CDC and the Defense Threat Reduction Agency have jointly committed to accelerate progress on global health security by co-developing a strategy and devoting $40 million toward activities focusing on advancing the U.S. government's GHS objectives in ten nations.

The FY 2015 President’s Budget will include an increase of $45 million within CDC to prevent avoidable catastrophes, detect threats early, and mobilize effective responses to contain outbreaks.  The increase also would allow CDC to partner with up to ten countries in 2015 to begin implementation and accelerate successful CDC efforts including training of field epidemiologists, developing new diagnostic tests, building capacities to detect new pathogens, building public health emergency management capacity, and supporting outbreak responses.

Secretary Sebelius, Ms. Monaco and Dr. Frieden were joined at the launch meeting by representatives in Washington and Geneva from 26 other countries, three international organizations, and by other U.S. government officials, including Deputy Secretary of State Heather Higginbottom, Acting Deputy Secretary of Defense Christine Fox, and Department of Agriculture Chief Veterinary Officer John Clifford, whose agencies will lead efforts to fulfill the U.S. government commitment to global health security.

“Efforts to prevent deadly outbreaks strengthen geopolitical stability and security, Agriculture Secretary Tom Vilsack said. “None of us, not the public health, security or agriculture sectors can accomplish global health security on our own—it is obvious that an interdisciplinary approach is the best way to make progress.”

HHS, DoS, USDA, and DoD will work closely with global partners to build countries’ global health security capacities in areas such as surveillance, detection and response in order to slow the spread of antimicrobial resistance, establish national biosecurity systems, reduce zoonotic disease transmission, increase routine immunization, establish and strengthen national infectious disease surveillance and laboratory systems, and develop public health electronic reporting systems and emergency operations centers.

“The Global Health Security Agenda set forth today establishes a roadmap for progress that ultimately depends on collaboration between the health and security communities,” said Acting Deputy Defense Secretary Fox. “The Department of Defense is committed to continuing our work, together with our national and international partners, to strengthen global health security.”

Countries joining the United States to meet the Global Health Security goals at today’s launch were Argentina, Australia, Canada, Chile, China, Ethiopia, Finland, France, Georgia, Germany, India, Indonesia, Italy, Japan, Kazakhstan, Mexico, Netherlands, Norway, Republic of Korea, Russian Federation, Saudi Arabia, South Africa, Turkey, Uganda, United Kingdom, and, Vietnam.

GSA SAYS NEW CDC LEASE SAVES $29 MILLION

FROM:  GENERAL SERVICES ADMINISTRATION 
GSA Announces New Lease for Centers for Disease Control & Prevention
Deal saves $29 million taxpayer dollars in lease payments  

WASHINGTON, DC -- Today, the U.S. General Services Administration (GSA) announced a new lease agreement for the Centers for Disease Control and Prevention’s National Center for Health Statistics in Hyattsville, Maryland. The deal saves taxpayers approximately $29 million over the 15-year term of the lease, while providing space that the Centers for Disease Control and Prevention needs to fight disease and provide health information that protects our nation against health threats.

The new lease deal will keep the Centers for Disease Control and Prevention (CDC) at its Hyattsville location. The building will be renovated to accommodate additional personnel allowing the CDC to reduce its need for other leases and shrink its footprint by more than 70,000 square feet. The reduced space accounts for the savings over the course of the lease. Additionally, the lease incorporates many sustainable upgrades, resulting in a building that is expected to be Energy Star certified and the tenant space will be certified under the LEED-Commercial Interiors rating system.

The lease award is the result of an open and competitive procurement. The selected offer met all the minimum requirements of the April 2013 Request for Lease Proposals and was the lowest priced offer providing the best value to the taxpayers.

CDC REPORTS ON VIRAL SUPPRESSION OF HIV INFECTION

FROM:  CENTERS FOR DISEASE CONTROL 

Prevalence and Predictors of Viral Suppression Among Persons with Diagnosed HIV Infection Retained in Care — Georgia, 2010

Not all persons with HIV who are receiving and remain in medical care achieve the goal of viral suppression, and fewer persons diagnosed with early stage disease achieve viral suppression compared with persons diagnosed with late stage disease. Health-care providers and community-based organizations should implement the national HIV treatment guidelines by initiating antiretroviral therapy (ART) at any stage of disease and explain to patients the benefits of taking ART earlier and regularly to achieve viral suppression. Early diagnosis of HIV infection and treatment to achieve viral suppression can benefit patients by improving their health status and the community by reducing HIV transmission. This analysis in Georgia, however, found that some persons who receive and remain in care don’t achieve viral suppression. In addition, the analysis found fewer persons diagnosed with early stage disease achieved viral suppression compared with persons diagnosed with late stage disease.

CDC SAYS DENGUE VIRUS INFECTION MAY BE UNDER REPORTED IN U.S..

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Fatal Hemophagocytic Lymphohistiocytosis Associated with Locally Acquired Dengue Virus Infection — New Mexico and Texas, 2012

Dengue may be under recognized in the United States; clinicians should request diagnostic testing of suspected dengue cases and report confirmed cases to state and local health departments. This report describes a woman who was infected with dengue virus in the southern United States and died from a rare complication of dengue called hemophagocytic lymphohistiocytosis. The woman was initially diagnosed with West Nile fever and was not suspected of having dengue because the symptoms are sometimes associated with bleeding. Most people with dengue will not have severe bleeding, which is diagnostically linked with the disease. This case may suggest that there are more unrecognized cases of dengue in the United States. Although dengue outbreaks have recently occurred in Florida, Texas and Hawaii, the largest disease burden in the 50 United States will continue to be in travelers. Individuals who travel to areas where dengue is common should protect themselves from mosquito bites to reduce their risk of infection.

CDC ON TREATING HEAD LICE

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION

Head lice. Every parent’s nightmare.
A year-round problem, the number of cases seems to peak when the kids go back to school in the fall and again in January, says Patricia Brown, M.D., a dermatologist at the Food and Drug Administration (FDA).

An estimated 6 to 12 million cases of head lice infestation occur each year in the United States in children 3 to 11 years of age, according to the Centers for Disease Control and Prevention. Head lice are most common among preschool children attending child care, elementary school children, and household members of children who have lice.

Contrary to myth, head lice are not caused by poor hygiene, Brown says. They are spread mainly by direct head-to-head contact with a person who already has head lice. You cannot get head lice from your pets; lice feed only on humans.

Lice don’t fly or jump; they move by crawling. But because children play so closely together and often in large groups, lice can easily travel from child to child, especially when they touch heads during playing or talking.


Blood-Sucking Bugs

Head lice are blood-sucking insects about the size of a sesame seed and tan to grayish-white in color. They attach themselves to the skin on the head and lay eggs (nits) in the hair.

According to Brown, you can check for head lice or nits by parting the hair in several spots. You can use a magnifying glass and a bright light to help spot them. Because head lice can move fast it may be easier to spot the nits. Nits can look like dandruff, but you can identify them by picking up a strand of hair close to the scalp and pulling your fingernail across the area where you suspect a nit. Dandruff will come off easily, but nits will stay firmly attached to the hair, Brown explains.

FDA-approved treatments for head lice include both over-the-counter (OTC) and prescription drugs, such as Nix and Rid, in the form of shampoos, creams and lotions. “Many head lice products are not for use in children under the age of 2, so read the label carefully before using a product to make sure it is safe to use on your child,” Brown says.

Although OTC drugs are available for treatment of head lice, Brown says your health care professional may prescribe drugs recently approved by the FDA, such as Ulesfia (approved in 2009), Natroba (approved in 2011) or Sklice (approved in 2012).


Steps for Safe Use

Follow these steps to use any head lice treatment safely and appropriately:
After rinsing the product from the hair and scalp, use a fine-toothed comb or special “nit comb” to remove dead lice and nits.

Apply the product only to the scalp and the hair attached to the scalp—not to other body hair.

Before treating young children, talk with the child’s doctor or your pharmacist for recommended treatments based on a child’s age and weight.
Use medication exactly as directed on the label and never more often than directed unless advised by your health care professional.
Use treatments on children only under the direct supervision of an adult.

Heading Off Head Lice

Teach children to avoid head-to-head contact during play and other activities at home, school, and elsewhere (sports activities, playgrounds, slumber parties, and camps).

Teach children not to share clothing and supplies, such as hats, scarves, helmets, sports uniforms, towels, combs, brushes, bandanas, hair ties, and headphones.
Disinfest combs and brushes used by a person with head lice by soaking them in hot water (at least 130°F) for 5–10 minutes.

Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with a person with head lice.

Clean items that have been in contact with the head of a person with lice in the 48 hours before treatment. Machine wash and dry clothing, bed linens, and other items using hot water (130°F) and a high heat drying cycle. Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for two weeks.

Vacuum the floor and furniture, particularly where the person with lice sat or lay. Head lice survive less than one or two days if they fall off the scalp and cannot feed.

Do not use insecticide sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin.

After finishing treatment with lice medication, check everyone in your family for lice after one week. If live lice are found, contact your health care professional.
Heading Off Head Lice source: Centers for Disease Control and Prevention
This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

Updated: January 23, 2014

CDC SAYS "OPPORTUNITY FOR CHOICE" EXISTS IF SODIUM LOWERED IN RESTAURANT FOODS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Press Release Reducing sodium in restaurant foods is an opportunity for choice
Communities reduce, replace, reformulate to offer lower-sodium options

Americans eat out at fast food or dine-in restaurants four or five times a week. Just one of those meals might contain more than an entire day’s recommended amount of sodium. CDC has strategies for health departments and restaurants to work together to offer healthier choices for consumers who want to lower their sodium intake. The report, “From Menu to Mouth: Opportunities for Sodium Reduction in Restaurants,” is published in today’s issue of CDC’s journal, Preventing Chronic Disease.

On average, foods from fast food restaurants contain 1,848 mg of sodium per 1,000 calories and foods from dine-in restaurants contain 2,090 mg of sodium per 1,000 calories. The U. S. Dietary Guidelines recommend the general population limit sodium to less than 2,300 mg a day. Too much sodium can cause high blood pressure, one of the leading causes of heart disease and stroke.

“The bottom line is that it’s both possible and life-saving to reduce sodium, and this can be done by reducing, replacing and reformulating,” said CDC Director Tom Frieden, M.D., M.P.H. “When restaurants rethink how they prepare food and the ingredients they choose to use, healthier options become routine for customers.”

CDC WARNS HOSPITALS TO RESERVE ZINC SUPPLIES DURING NATIONAL SHORTAGES

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Zinc Deficiency–Associated Dermatitis in Infants During a Nationwide Shortage of Injectable Zinc — Washington, DC, and Houston, Texas, 2012–2013

Duke J. Ruktanonchai, M.D.
Lieutenant Commander, U.S. Public Health Service
CDC Epidemic Intelligence Service Officer
Texas Department of State Health Services

During national shortages of injectable zinc, hospitals should consider reserving supplies for infants at highest risk for deficiency. Injectable zinc, a vital component of parenteral nutrition (PN) formulations, was reported to be in short supply in 2012. Early reports resulted in the publication of a MMWR notice regarding the shortage and early reports of problems in premature infants. Premature and low birth weight (LBW) infants are especially vulnerable to micronutrient deficiencies.  This report discusses investigation into the effects of the shortage on a group of premature infants in two states. Through collaboration of CDC, FDA, the American Academy of Pediatrics, hospitals, and clinicians, public health actions were taken to prevent zinc deficiency disorders in vulnerable infants during the shortage.

CDC REPORT ON DANGEROUS WATER SCUM

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Freshwater Algal Bloom–Associated Disease Outbreaks Among Users of Untreated Recreational Waters — United States, 2009 –2010 

Harmful algal blooms commonly occur in freshwater bodies. They can create bad odors, they can discolor the water or accumulate as a scum on the surface of the water. People should avoid, and animals should be kept from, and neither should drink directly from lakes and ponds that have a scum on the water. People should also observe any local water advisories. Eleven waterborne disease outbreaks reported to CDC in 2009–2010 were linked to harmful algal blooms (HABs) in freshwater lakes during summer months. The outbreaks most often affected people less than 20 years old. HABs tend to occur in warm bodies of water that are rich in nutrients and often produce a visible algal scum on the water. HABs might generate toxins that can make humans sick and cause death among fish, birds and dogs. Ill people report a range of health effects, including neurologic symptoms (for example, confusion), diarrhea, cough, rash, and earache. Health-care providers should consider HAB—toxin exposure as a possible cause of illness in people who have been in or alongside freshwater bodies with algal blooms. Future increases in water temperature and nutrient pollution are expected to result in an increase in the number of HABs in freshwater lakes.

CDC SAYS LUNG CANCER NEW CASES DECREASED FROM 2005-2009

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Rates of new lung cancer cases drop in U.S. men and women
CDC report finds fastest drop in adults aged 35-44 years

Tobacco control efforts are having a major impact on Americans’ health, a new analysis of lung-cancer data suggests. The rate of new lung cancer cases decreased among men and women in the United States from 2005 to 2009, according to a report in this week’s Morbidity and Mortality Weekly Report.

The study also found that lung cancer incidence rates went down 2.6 percent per year among men, from 87 to 78 cases per 100,000 men and 1.1 percent per year among women, from 57 to 54 cases per 100,000 women.

The fastest drop was among adults aged 35-44 years, decreasing 6.5 percent per year among men and 5.8 percent per year among women. Lung cancer incidence rates decreased more rapidly among men than among women in all age groups. Among adults aged 35-44 years, men had slightly lower rates of lung cancer incidence than women.

“These dramatic declines in the number of young adults with lung cancer show that tobacco prevention and control programs work – when they are applied,” said CDC Director Tom Frieden, M.D., M.P.H.

Lung cancer is the leading cause of cancer death and the second most commonly diagnosed cancer among both men and women in the United States. Most lung cancers are attributable to cigarette smoking and secondhand smoke. Because smoking behaviors among women are now similar to those among men, women are now experiencing the same risk of lung cancer as men.

“While it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many,” Dr. Frieden said. “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.”

In 2010, states appropriated only 2.4 percent of their tobacco revenues for tobacco control. An earlier CDC study showed that states vary widely in their success at reducing smoking – and in reducing new lung cancers.

In the new report, CDC used data from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End ResultsExternal Web Site Icon program for the period 2005–2009 to assess lung cancer incidence rates and trends among men and women by age group.
Lung cancer incidence decreased among men in all U.S. Census regions and 23 states, and decreased among women in the South and West and seven states. Rates were stable in all other states. These declines reflect the successes of past tobacco prevention and control efforts.

The study indicates that continued attention to local, state, and national population-based tobacco prevention and control strategies are needed to achieve further reductions in smoking prevalence among both men and women of all ages to reduce subsequent lung cancer in the United States. Strategies proven to reduce tobacco use among youth and adults include increased tobacco prices, comprehensive smoke-free laws, restriction of tobacco advertising and promotion, and hard-hitting mass media and community engagement campaigns.

This month marks the 50th anniversary of the first Surgeon General's Report linking cigarette smoking to lung cancer. Smoking remains the leading cause of preventable death and disease in the United States. Millions of Americans are living with a smoking-related disease, and each day more than 2,100 youth and young adults become daily smokers.

Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as tobacco use screenings and tobacco cessation services that may be covered with no additional costs.

CDC SAYS MOST HEALTH CARE PROVIDERS DON'T DISCUSS ALCOHOL USE

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION

Most health care providers don’t talk about alcohol, even when patients drink too much.

Alcohol screening and counseling is an effective but underused health service
Only one in six adults -- and only one in four binge drinkers -- say a health professional has ever discussed alcohol use with them even though drinking too much is harmful to health, according to a new Vital Signs report from the Centers for Disease Control and Prevention.

Even among adults who binge drink 10 or more times a month, only one in three have ever had a health professional talk with them about alcohol use. Binge drinking is defined as consuming four or more drinks for women and five or more drinks for men within 2-3 hours. Talking with a patient about their alcohol use is an important first step in screening and counseling, which has been proven effective in helping people who drink too much to drink less.

A drink is defined as five ounces of wine, 12 ounces of beer, or 1.5 ounces of 80-proof distilled spirits or liquor. At least 38 million adults in the United States drink too much. Most are not alcoholics. Drinking too much causes about 88,000 deaths in the United States each year, and was responsible for about $224 billion in economic costs in 2006. It can also lead to many health and social problems, including heart disease, breast cancer, sexually transmitted diseases, fetal alcohol spectrum disorders, motor-vehicle crashes, and violence.

Alcohol screening and brief counseling can reduce the amount of alcohol consumed on an occasion by 25 percent among those who drink too much. It is recommended for all adults, including pregnant women. As with blood pressure, cholesterol and breast cancer screening, and flu vaccination, it has also been shown to improve health and save money. Through the Affordable Care Act, alcohol screening and brief counseling can be covered by most health insurance plans without copay.

“Drinking too much alcohol has many more health risks than most people realize,” said CDC Director Tom Frieden, M.D., M.P.H. “Alcohol screening and brief counseling can help people set realistic goals for themselves and achieve those goals. Health care workers can provide this service to more patients and involve communities to help people avoid dangerous levels of drinking.”

Health professionals who conduct alcohol screening and brief counseling use a set of questions to screen all patients to determine how much they drink and assess problems associated with drinking. This allows them to counsel those who drink too much about the health dangers, and to refer those who need specialized treatment for alcohol dependence. CDC used 2011 Behavioral Risk Factor Surveillance System data to analyze self-reports of ever being “talked with by a health provider” about alcohol use among U.S. adults aged 18 and older from 44 states and the District of Columbia.

No state or district had more than one in four adults report that a health professional talked with them about their drinking, and only 17 percent of pregnant women reported this. Drinking during pregnancy can seriously harm the developing fetus.

Through the Affordable Care Act, more Americans will have access to health coverage and to no-cost preventive services like alcohol misuse screening and counseling. Visit Healthcare.gov to learn more. Open enrollment in the Marketplace began October 1 and ends March 31, 2014. For those enrolled by Dec. 15, 2013, coverage starts as early as Jan. 1, 2014.

CDC: INJURY AND VIOLENCE PREVENTION

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
CDC Grand Rounds: Evidence-Based Injury and Violence Prevention
CDC Media Relations
404-639-3286

Most events resulting in injury, death, or disability are predictable, and therefore preventable. In the United States, injuries result in 180,000 deaths, 2.8 million hospitalizations and 29 million emergency department visits each year. Motor vehicle crashes, falls, homicides, suicides, domestic violence, child maltreatment, and other forms of intentional and unintentional injury produce substantial economic and societal burdens. The estimated annual U.S. cost in medical expenses and lost productivity resulting from injuries is $355 billion. Injury and violence prevention strategies and interventions are identified and tested in real-world settings. Communities can attain maximum impact by recognizing that injury prevention is a core component of public health.  Injury prevention efforts should be visible, with their value documented to ensure accountability and increase impact in communities. Innovative solutions to injury problems should be pursued, and opportunities to link clinical medicine and public health should be fostered. Translating injury prevention evidence into action depends on coordination among federal, state, and local agencies, and partnerships in the research and practice communities.

CDC NOTES HISTOPLASMOSIS OUTBREAK IN QUEBEC WHEN OLD HOUSE RENOVATED

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Histoplasmosis Outbreak Associated with the Renovation of an Old House — Quebec, Canada, 2013

Weekly

January 3, 2014 / 62(51);1041-1044

On May 19, 2013, a consulting physician contacted the Laurentian Regional Department of Public Health (Direction de santé publique des Laurentides [DSP]) in Quebec, Canada, to report that two masons employed by the same company to do demolition work were experiencing cough and dyspnea accompanied by fever. Other workers also were said to be ill. DSP initiated a joint infectious disease, environmental health, and occupational health investigation to determine the extent and cause of the outbreak. The investigation identified 14 persons with respiratory symptoms among 30 potentially exposed persons. A strong correlation was found between exposure to demolition dust containing bat or bird droppings and a diagnosis of histoplasmosis. Temporary suspension of construction work at the demolition site in Saint-Eustache, Quebec, northwest from Montreal, and transport of the old masonry elements to a secure site for burial were ordered, and information about the disease was provided to workers and residents. To prevent future outbreaks, recommendations included disinfection of any contaminated material, disposal of waste material with proper control of aerosolized dust, and mandatory use of personal protective equipment such as gloves, protective clothing, and adequate respirators.

Histoplasmosis is an infectious disease caused by inhalation of spores produced by the fungus Histoplasma capsulatum (HC) (1,2). The organism can be excreted by bats and birds in their droppings and can persist in the environment for several years (3). Pulmonary infection sometimes causes symptoms typical of pneumonia (e.g., dyspnea, fever, and thoracic pain). The incubation period varies ranges from 7 to 21 days. Renovation of old houses that have sheltered colonies of bats has been associated with histoplasmosis resulting from worker exposure to aerosolized spores of the fungus (4–6). Disseminated histoplasmosis is a rare form of the infection that can be fatal, even if properly treated.

On May 19, 2013, a consulting physician contacted DSP to report that two masons employed by the same company were experiencing cough and dyspnea accompanied by fever. Other workers were also reported to be sick. A joint infectious disease, environmental health, and occupational health investigation was initiated by DSP. The objectives of the investigation were to describe the demolition work, the workers, and other persons involved, and the medical history of persons who became ill, to determine the extent and cause of the outbreak.

Initial questioning revealed that the two workers became ill 48 hours earlier. Because of the severity of the symptoms, both patients were referred to the emergency department of a Montreal tertiary-care center. One of the two patients was hospitalized. Further investigation revealed that during May 18–20, 2013, six masons were evaluated in the emergency department for similar symptoms, and two were hospitalized. All the masons had recently carried out demolition of the exterior walls of a century-old brick house and had seen a large quantity of dried bird or bat droppings behind the bricks. The demolition work was reported to have caused a cloud of dust in the immediate environment. Given the history of exposure to droppings, the diagnosis of histoplasmosis was considered.

The investigation led to the identification and questioning of the 30 persons believed to have been exposed to HC from work-site debris during April 29–May 14, 2013. Those 30 included 21 men and nine women, with a mean age of 39 years (median: 30.8 years, range: 16–77 years). A standardized questionnaire was used to record symptoms and determine potential exposures. Half of the exposed person were workers: six masons who demolished the brick walls, four bricklayers, one debris sorter working for a container company from outside the Laurentian region who picked up the demolition debris and transported it to a sorting site away from the demolition site, two other debris sorters from the same company who cleaned the bricks, and two metal workers from a third company who carried out repairs to the roof eaves. The other 15 persons included the homeowner and his wife, who lived on the ground floor of the house, and two tenants living upstairs; three visitors who walked around on the site for 10–90 minutes; and eight neighbors.

Of these 30 persons, 14 experienced respiratory symptoms: six masons, three debris sorters, the two residents on the ground floor, the two neighbors whose bedroom faced the demolition site, and one of the visitors to the site (Table). These 14 persons consulted a physician. Two workers were hospitalized. Symptoms began to appear during May 2–17, with a peak occurring May 13–17 (Figure). In order of frequency, the symptoms were dyspnea (100%), chills (86%), headaches (86%), sweating (79%), chest pain (79%), asthenia (79%), fever (71%), cough (71%), myalgia (57%), nausea (43%), diarrhea (36%), erythema (29%), abdominal pain (14%), and vomiting (14%). The average duration of respiratory symptoms was 12.6 days (median: 13.5 days; range: 5–20 days). All the symptomatic persons recovered without any specific treatment for histoplasmosis.

A clinical case of histoplasmosis was defined as the presentation of at least four of the following symptoms: dyspnea, chest pain, cough, fever, chills, sweating, asthenia, or myalgia, with onset during April 30–May 19, 2013, in a person exposed to the demolition site or involved in the handling of demolition debris during April 29–May 14, 2013. A confirmed case was defined as a case meeting the clinical case definition plus detection of HC antigen in a serum or urine specimen. All of the 14 persons who had respiratory symptoms met at least the clinical case definition. Hospitalized patients underwent radiologic investigation, in conjunction with blood and microbiologic analysis, to rule out other viral, bacterial, or fungal infections, including legionellosis and tuberculosis.

A diagnosis of histoplasmosis was confirmed for the two hospitalized masons through a positive serum and a positive urinary HC antigen test. The diagnosis for the two debris sorters was confirmed by a urinary HC antigen test. Five of the other 11 workers received a clinical diagnosis of histoplasmosis resulting from exposure to the same material as the confirmed cases, the presence of compatible clinical manifestations and chest radiographs demonstrating abnormalities. Among the 15 residents, visitors, and neighbors, the illnesses of five were considered clinical cases of histoplasmosis.

Exposure was categorized as high in persons who directly manipulated contaminated material during the demolition, transportation, or debris removal, and in persons who lived in the house during the renovation. If not present during those activities, persons were considered to have experienced low exposure.

Among the 13 persons categorized as having been highly exposed, 11 experienced symptoms, compared with three of 17 persons with a low level of exposure (relative risk = 4.8, 95% confidence interval = 1.7–13.7) (Table). Simply being present during the demolition (April 29–May 1) was also strongly associated with infection. Of 23 persons present, 14 experienced symptoms, compared with none of the seven persons exposed after demolition (relative risk = ∞, 95% confidence interval = undetermined; p<0.005).

The recommendations made by DSP consisted of temporarily suspending any further construction work and informing the workers and the residents about the disease. The risk for additional contamination from the house's environment was assessed. The old bricks from the demolition debris were contained and buried underground at a secure site. The debris around the house was removed by workers before involvement of DSP. The house's surroundings were washed by heavy rains during the following days. The Laurentian Regional Occupational Health and Safety Commission also made recommendations to the employers concerning similar work in the future: communicate health risks to workers and insist on preventive measures, particularly the constant use of a respirator. Although the masons were provided with respirators, they wore them intermittently because of the hot weather; respirators were not made available for the three debris sorters.

Reported by

André Allard, FRCPC, Denise Décarie, MD, Jean-Luc Grenier, MD, Marie-Claude Lacombe, MD, Francine Levac, MD, Laurentian Regional Dept of Public Health, Saint-Jérôme, Québec, Canada. Corresponding contributor: Jean-Luc Grenier, jean-luc_grenier@ssss.gouv.qc.ca, 

Editorial Note

A wide range of activities have been associated with histoplasmosis outbreaks: construction, maintenance, renovation, excavation (4–6); caving (7); school activities or day camp (8); search for treasure (9); and agricultural activities (10), among others. The common variable inherent in these activities is the exposure to bird or bat droppings (1) or contaminated soil.

When buildings, particularly old houses, have previously sheltered colonies of bats or birds, appropriate measures should be taken before starting renovation work to protect the health of persons in and around the area.

In this investigation, the confirmation of a diagnosis of histoplasmosis for debris sorters who did not work at the demolition site but handled contaminated materials away from the site demonstrates that the radius of exposure might be greater than expected. As a result, protective measures should be recommended to all workers who might be exposed to contaminated material.

The findings in this report are subject to at least two limitations. First, a conservative approach to risk assessment was adopted by including persons such as residents of the house in the high exposure scenario, and by including clinical cases that could be related to an etiology other than histoplasmosis. Second, the small number of persons involved in this outbreak limits the power of analysis and the conclusions that can be drawn from the investigation. Moreover, the even smaller number of symptomatic persons who were tested for HC antigen reduces the specificity of the diagnosis. Despite these limitations, the high relative risk shows a strong correlation between demolition dust exposure and the onset of disease.

This outbreak highlights the importance for employers to understand the health risks associated with renovation of old houses in areas where bats or birds roost. Employers should also be made aware of the recommended health measures for their workers, such as wearing a respirator (1).

Acknowledgments

Bruno Cossette, Linda Montplaisir, Francine Veilleux, Laurentian Regional Dept of Public Health, Saint-Jérôme, Québec, Canada.

References

1. Public Health Agency of Canada. Histoplasma capsulatum: pathogen safety data sheet-infectious substances. Ottawa, Ontario, Canada: Public Health Agency of Canada; 2011. Available at http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/histoplasma-capsulatum-eng.php.
2. McKinsey DS, McKinsey JP. Pulmonary histoplasmosis. Semin Respir Crit Care Med 2011;32:735–44.
3. CDC. Histoplasmosis. Atlanta, GA: US Department of Health and Human Services, CDC; 2013. Available athttp//www.cdc.gov/fungal/histoplasmosis.
4. Fernandez Andreu CM, Martínez Machín G, Illnait Zaragozi MT, Perurena Lancha MR, González L. Outbreaks of occupational acquired histoplasmosis in La Habana province. Rev Cubana Med Trop 2010;62:68–72.
5. Anderson H, Honish L, Taylor G, et al. Histoplasmosis cluster, golf course, Canada. Emerg Infect Dis 2006;12:163–5.
6. Huhn GD, Austin C, Carr M, et al. Two outbreaks of occupationally acquired histoplasmosis: more than workers at risk. Environ Health Perspect 2005;113:585–9.
7. Lyon GM, Bravo AV, Espino A, et al. Histoplasmosis associated with exploring a bat-inhabited cave in Costa Rica, 1998–1999. Am J Trop Med Hyg 2004;70:438–42.
8. CDC. Notes from the field: histoplasmosis outbreak among day camp attendees—Nebraska, June 2012. MMWR 2012;61:747–8.
9. Corcho-Berdugo A, Muñoz-Hernández B, Palma-Cortés G, et al. An unusual outbreak of histoplasmosis in residents of the state of Mexico. Gac Med Mex 2011;147:377–84.
10. CDC. Outbreak of histoplasmosis among industrial plant workers—Nebraska, 2004. MMWR 2004;53:1020–2.

What is already known on this topic ?

Histoplasmosis outbreaks can occur when demolition work produces dust containing bird or bat droppings.

What is added by this report?

During the renovation of an old house in Quebec, Canada, 14 of 30 workers and residents exposed to dust from bird or bat droppings experienced respiratory symptoms consistent with histoplasmosis. Of the four persons whose infection was laboratory-confirmed, two were hospitalized. Illness was highly correlated with exposure to dust during demolition of the exterior walls, and with the handling of contaminated debris away from the work site.

What are the implications for public health practice?

Employers need to provide the appropriate protective equipment and reinforce to employees the necessity of applying protective measures during demolition work, including when handling debris away from the work site.

CDC TOUTS BENEFITS OF INFLUENZA VACCINATIONS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Influenza Illnesses and Hospitalizations Averted by Influenza Vaccination — United States, 2012–13 Influenza Season

Influenza vaccination produces a substantial health benefit in terms of preventing illness, medical visits and hospitalizations, but further raising vaccination rates and producing more effective vaccines would greatly increase the benefits realized by influenza vaccination in the United States. In this report, CDC uses a model first published in June 2013 to estimate the number of influenza-associated illnesses, medically attended illnesses and hospitalizations that were prevented last season as a result of flu vaccination. Based on this model, CDC estimates that flu vaccination in 2012-2013 reduced the numbers of flu illnesses, medically attended illnesses and hospitalizations by 17 percent over what would have occurred in the absence of influenza vaccination. This report shows the benefits of the flu vaccination program in terms of reducing flu illnesses, including serious illnesses resulting in hospitalizations.

CDC REPORT ON SUDDEN CARDIAC DEATHS ASSOCIATED WITH LYME CARDITIS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States, November 2012–July 2013

Lyme carditis is a known but rare cause of sudden cardiac death. Lyme carditis can cause heart palpitations, chest pain, light-headedness, fainting, and shortness of breath in addition to the commonly recognized Lyme disease symptoms of fever, rash, and body aches. If you live in an area where Lyme disease is common and have these symptoms, see a healthcare provider immediately. Between November 2012 and July 2013, three young adults who lived in high-incidence Lyme disease regions suffered from sudden cardiac death associated with undiagnosed Lyme carditis. Lyme carditis is a known, but rare cause of death in persons who have Lyme disease. The CDC and state and local health departments investigated these three deaths. Two of the three individuals who died had corneas transplanted to three separate recipients before the cause of death was notified, but there was no evidence of disease transmission. Prompt recognition and early, appropriate therapy for Lyme disease with antibiotics is essential. These deaths underscore the urgent need for better methods of primary prevention of Lyme disease and other tickborne infections.

MEASLES STILL A THREAT 50 YEARS AFTER MEASLES VACCINE APPROVED

FROM:  U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION 
Press Release Measles Still Threatens Health Security
On 50th Anniversary of Measles Vaccine, Spike in Imported Measles Cases

Fifty years after the approval of an extremely effective vaccine against measles, one of the world’s most contagious diseases, the virus still poses a threat to domestic and global health security.

On an average day, 430 children – 18 every hour – die of measles worldwide. In 2011, there were an estimated 158,000 measles deaths.

In an article published on December 5 by JAMA Pediatrics, CDC’s Mark J. Papania, M.D., M.P.H., and colleagues report that United States measles elimination, announced in 2000, has been sustained through 2011. Elimination is defined as absence of continuous disease transmission for greater than 12 months. Dr. Papania and colleagues warn, however, that international importation continues, and that American doctors should suspect measles in children with high fever and rash, “especially when associated with international travel or international visitors,” and should report suspected cases to the local health department. Before the U.S. vaccination program started in 1963, measles was a year-round threat in this country. Nearly every child became infected; each year 450 to 500 people died each year, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness.

People infected abroad continue to spark outbreaks among pockets of unvaccinated people, including infants and young children. It is still a serious illness: 1 in 5 children with measles is hospitalized. Usually there are about 60 cases per year, but 2013 saw a spike in American communities – some 175 cases and counting – virtually all linked to people who brought the infection home after foreign travel.

CDC FINDINGS RELEASED REGARDING IMPROVING FOOD SAFETY IN RESTAURANTS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
CDC releases new findings and prevention tools to improve food safety in restaurants

Increased awareness and implementation of proper food safety in restaurants and delis may help prevent many of the foodborne illness outbreaks reported each year in the United States, according to data from the Centers for Disease Control and Prevention.  Researchers identified gaps in the education of restaurant workers as well as public health surveillance, two critical tools necessary in preventing a very common and costly public health problem.

The research identifies food preparation and handling practices, worker health policies, and hand-washing practices among the underlying environmental factors that often are not reported during foodborne outbreaks, even though nearly half of all the foodborne outbreaks that are reported each year are associated with restaurants or delis. Forty-eight million people become ill and 3,000 die in the United States.

"Inspectors have not had a formal system to capture and report the underlying factors that likely contribute to foodborne outbreaks or a way to inform prevention strategies and implement routine corrective measures in restaurants, delis and schools to prevent future outbreaks," said Carol Selman, head of CDC's Environmental Health Specialists Network team at the National Center for Environmental Health.

Four articles published today in the Journal of Food Protection focus on actions steps to prevent foodborne illness outbreaks related to ground beef, chicken, and leafy vegetables like lettuce and spinach. The articles also focus on specific food safety practices, such as ill workers not working while they are sick, as a key prevention strategy.

Since 2000, CDC has worked with state and local health departments to develop new surveillance and training tools to advance the use of environmental health assessments as a part of foodborne outbreak investigations.

The National Voluntary Environmental Assessment Information System (NVEAIS) is a new surveillance system targeted to state, tribal and other localities that inspect and regulate restaurants and other food venues such as banquet facilities, schools, and other institutions. The system provides an avenue to capture underlying environmental assessment data that describes what happened and how events most likely lead to a foodborne outbreak. These data will help CDC and other public health professionals determine and understand more completely the primary and underlying causes of foodborne illness outbreaks.

A free interactive e-learning course has been developed to help state and local health departments investigate foodborne illness outbreaks in restaurants and other food service venues as a member of a larger outbreak response team, identify an outbreak's environmental causes, and recommend appropriate control measures. This e-learning course is also available to members of the food industry, academia and the public, anyone interested in understanding the causes of foodborne outbreaks.

"We are taking a key step forward in capturing critical data that will allow us to assemble a big picture view of the environmental causes of foodborne outbreaks," Selman said.

The data surveillance system and e-Learning course will debut in early 2014. With these tools, state, and local public health food safety programs will be able to report data from environmental assessments as a part of outbreak investigations and prevent future foodborne outbreaks in restaurants and other food service establishments.

CDC developed these products in collaboration with the U.S. Food and Drug Administration, U.S. Department of Agriculture, and state and local health departments.

CDC REPORTS ON FIGHT AGAINST POLIO IN PAKISTAN AND AFGHANISTAN

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Progress and Challenges Fighting Polio in Pakistan and Afghanistan
Not reaching every child jeopardizes progress and risks re-introduction in other parts of the world

Both Pakistan and Afghanistan saw an overall decrease in wild poliovirus (WPV) cases from January – September 2013 compared with the same time period in 2012 according to data published in the Morbidity and Mortality Weekly Report (MMWR) released today by the Centers for Disease Control and Prevention (CDC).  Since 2012, transmission of indigenous WPV has been limited to three countries: Afghanistan, Pakistan, and Nigeria.  Results for Nigeria will be released in December.

Both countries still face significant challenges in reaching unvaccinated children.  Afghanistan is fighting a polio outbreak in the Eastern Region while Pakistan continues to see polio increases in the conflict-affected Federally Administered Tribal Areas (FATA), where there is a ban on polio vaccination, and in security-compromised Khyber Pakhtunkhwa Province. The potential risk of transmission to other countries highlights the need for strong ongoing global efforts to eradicate this disease.

“Although there have been setbacks, we are making progress towards global polio eradication,” said CDC Director Dr. Tom Frieden, M.D., M.P.H. “There is encouraging progress in Afghanistan, but, as long as transmission is uninterrupted in Pakistan and Nigeria, the risk for spread to other countries continues because polio anywhere presents a threat of polio everywhere."

In Afghanistan, confirmed cases of WPV dropped from 80 in 2011 to 37 in 2012.  The downward trend continues for 2013 with only eight cases confirmed during January–September 2013, compared with 26 during the same period in 2012.  All eight polio cases in 2013 were in the Eastern Region and originated from the wild poliovirus in Pakistan.

This week Afghanistan achieved a significant milestone - 12 months without any recorded cases of wild poliovirus in the traditionally polio-endemic provinces of Kandahar and Helmand, long recognized as Afghanistan's epicentres of polio.  This unprecedented progress is an endorsement of the effectiveness of the polio eradication programs and their implementation in the Southern Region.    

akistan reported a decrease from 198 WPV cases throughout the country in 2011 to 58 in 2012 in selected areas.  Fifty-two cases were reported during January–September 2013, compared with 54 cases during the same period in 2012.   However, because of additional cases since September, 2013 Pakistan has now surpassed the 2012 numbers, thus reversing the downward trend.   Eighty-four percent of cases reported since January 2012 occurred in the FATA and Khyber Pakhtunkhwa Province.

Approximately 350,000 children in the FATA have not received polio vaccines during immunization campaigns conducted since mid-2012 because local authorities have banned vaccination. In other areas of Pakistan, polio vaccination teams have encountered increased security threat-levels, hindering immunization programs.  Further multi-pronged efforts to reach children in conflict-affected and security-compromised areas will be necessary to prevent WPV re-introduction into other areas of Pakistan and other parts of the world.  This situation requires all countries to take additional public health actions to strengthen detection and strengthen protection by enhancing polio surveillance programs and intensifying vaccination efforts.

CDC SAYS DIAGNOSES OF ADHD RISING AMONG U.S. CHILDREN

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
ADHD Estimates Rise
Continued Increases in ADHD Diagnoses and Treatment with Medication among U.S. Children

Two million more children in the United States have been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and one million more U.S. children were taking medication for ADHD over an 8 year period (2003-2004 to 2011-2012), according to a new study Adobe PDF file [1.81 MB]External Web Site Icon led by CDC. According to CDC scientists, children are commonly being diagnosed at a young age. Half of children diagnosed with ADHD are diagnosed by 6 years of age.  Children with more severe ADHD tend to be diagnosed earlier, about half of them by the age of 4, based on reports by parents.

ADHD is one of the most common chronic conditions of childhood. It often persists into adulthood. Children with ADHD may have trouble paying attention and/or controlling impulsive behaviors. Effective treatments for ADHD include medication, mental health treatment, or a combination of the two.  When children diagnosed with ADHD receive proper treatment, they have the best chance of thriving at home, doing well at school, and making and keeping friends.
In 2011-2012, 11 percent of U.S. children 4-17 years of age had been diagnosed with ADHD and 6.1 percent of U.S. children 4-17 years of age were taking medication for ADHD. Of the children with current ADHD, 69 percent were taking medication for ADHD treatment.

States vary widely in terms of the percentage of their child population diagnosed and treated with medication for ADHD. The percentage of children with a history of an ADHD diagnosis ranges from 15 percent in Arkansas and Kentucky to 4 percent in Nevada.

Medication treatment for ADHD is most common among children reported by their parents as having more severe ADHD.

Nearly one in five high school boys and one in 11 high school girls in the United States were reported by their parents as having been diagnosed with ADHD by a healthcare provider.

Note to parents: If you have concerns about your child’s behavior, complete the ADHD checklist, visit CDC's ADHD website and discuss your concerns with your child’s healthcare provider.

CDC REVEALS HEALTH DISPARITIES

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
CDC Report Documents Health Disparities
Highlights progress, challenges, and needs for stronger data

Income, education level, sex, race, ethnicity, employment status, and sexual orientation are all related to health and health outcomes for a number of Americans, according to a new Morbidity and Mortality Weekly Report Supplement released today by the Centers for Disease Control and Prevention (CDC).

The "CDC Health Disparities and Inequalities Report — United States, 2013," is the second CDC report that highlights differences in mortality and disease risk for multiple conditions related to behaviors, access to health care, and social determinants of health – the conditions in which people are born, grow, live, age, and work.

The latest report looks at disparities in deaths and illness, use of health care, behavioral risk factors for disease, environmental hazards, and social determinants of health. This year’s report contains 10 new topics including access to healthier foods, activity limitations due to chronic diseases, asthma attacks, fatal and nonfatal work-related injuries and illnesses, health-related quality of life, periodontitis in adults, residential proximity to major highways, tuberculosis, and unemployment.

“Better health for all Americans depends on focusing our efforts where they’re needed most,” said CDC Director Tom. Frieden, M.D., M.P.H." This kind of information helps us target health programs and promotes accountability for improving health equity at the federal, state and local level."
Some of the report’s key findings include:

The overall birth rate for teens 15-19 years old fell dramatically -- by 18 percent -- from 2007 to 2010.  Birth rate disparities also decreased because the rates fell by more among racial and ethnic minority populations that had higher rates.  However, across states, there was wide variation, from no significant change to a 30 percent reduction in the rate from 2007 to 2010.

Working in a high risk occupation -- an occupation in which workers are more likely than average to be injured or become ill -- is more likely among those who are Hispanic, are low wage earners, were born outside of the United States, have no education beyond high school, or are male.

Binge drinking is more common among persons aged 18-34 years, men, non-Hispanic whites, and persons with higher household incomes.
While the number of new tuberculosis cases in the United States decreased 58 percent from 1992 to 2010, tuberculosis continues to disproportionately affect racial and ethnic minorities, including foreign-born individuals.

The report also underscores the need for more consistent data on population characteristics that have often been lacking in health surveys, such as disability status and sexual orientation.  To help ensure that such data are more available in the future, the Affordable Care Act required the U.S. Department of Health and Human Services to develop a set of uniform data collection standards for national population health surveys.  These standards were published in 2011.
“It is clear that more needs to be done to address the gaps and to better assist Americans disproportionately impacted by the burden of poor health,” said Chesley Richards, M.D., M.P.H., director of CDC’s Office of Public Health Scientific Services, which produced the report.  “We hope that this report will lead to interventions that will allow all Americans, particularly those most harmed by health inequalities, to live healthier and more productive lives.”
The full "CDC Health Disparities and Inequalities Report — United States, 2013" and related information on the individual chapters is available at http://www.cdc.gov/DisparitiesAnalytics .

The Affordable Care Act can help to reduce health disparities in the United States.  Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services that are covered with no additional costs. Reducing disparities in health insurance coverage and access to care will contribute to health equity and is a key strategy of the U.S. Department of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities.  For those enrolled by December 15, 2013, coverage starts as early as January 1, 2014.

NEW GUIDELINES FOR SMARTER USE OF ANTIBIOTIC PRESCRIPTIONS FOR CHILDREN

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

New guidance limits antibiotics for common infections in children
Get Smart About Antibiotics Week 2013 calls for responsible antibiotic prescribing

Every year as many as 10 million U.S. children risk side effects from antibiotic prescriptions that are unlikely to help their upper respiratory conditions. Many of these infections are caused by viruses, which are not helped by antibiotics.
This overuse of antibiotics, a significant factor fueling antibiotic resistance, is the focus of a new report  Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in PediatricsExternal Web Site Icon by the American Academy of Pediatrics (AAP) in collaboration with the Centers for Disease Control and Prevention (CDC).

Released today during Get Smart About Antibiotics Week, the report amplifies recent AAP guidance and promotes responsible antibiotic prescribing for three common upper respiratory tract infections in children: ear infections, sinus infections, and sore throats.

Antibiotic resistance occurs when bacteria evolve and are able to outsmart antibiotics, making even common infections difficult to treat. According to a landmark CDC report from September 2013, each year more than two million Americans get infections that are resistant to antibiotics and 23,000 die as a result.
“Our medicine cabinet is nearly empty of antibiotics to treat some infections,” said CDC Director Tom Frieden, M.D., M.P.H.  “If doctors prescribe antibiotics carefully and patients take them as prescribed we can preserve these lifesaving drugs and avoid entering a post-antibiotic era.”

By providing detailed clinical criteria to help physicians distinguish between viral and bacterial upper respiratory tract infections, the recommendations provide guidance for physicians that will improve care for children. At the same time, it will help limit antibiotic prescriptions, giving bacteria fewer chances to become resistant and lowering children’s risk of side effects.

“Many people have the misconception that since antibiotics are commonly used that they are harmless,” says Dr. Lauri Hicks, a coauthor of the report and medical director of CDC’s Get Smart: Know When Antibiotics Work program. “Taking antibiotics when you have a virus can do more harm than good.”
These harms can be in the form of antibiotic side effects or promoting the development of antibiotic-resistant bacteria, which can then spread through a community.

CDC promotes responsible antibiotic use to consumers and health care providers through the combined efforts of the Get Smart: Know When Antibiotics Work and Get Smart for Healthcare programs, as well as during Get Smart About Antibiotics Week (Nov. 18–24, 2013) each year. State health departments, non-profit partners, and for-profit partners all contribute to the observance week’s success by spreading the word about when antibiotics work — and when they don’t.
This year’s activities include a Public Health Grand Rounds about the growing problem of antibiotic resistance in outpatient and inpatient settings on Tuesday, November 19 at 1 pm (EST).  In addition, a Twitter chat on the topic will be held Friday, November 22 at 1 pm (EST). Follow the hashtag #CDCchat on Twitter and join in the conversation to talk with Dr. Frieden, CDC experts and other partners about your experiences with antibiotic resistance.