WHITE HOUSE READOUT: PRESIDENT'S CALLS WITH PRESIDENT SIRLEAF OF LIBERIA, PRESIDENT KOROMA OF SIERRA LEONE

FROM:  THE WHITE HOUSE 

Readout of the President’s Calls to President Sirleaf of Liberia and President Koroma of Sierra Leone

President Obama spoke by phone today with President Ellen Johnson Sirleaf and separately with President Ernest Bai Koroma regarding the Ebola outbreak in West Africa. In his conversations with both leaders, the President underscored the commitment of the United States to work with Liberia, Sierra Leone, and other international partners to contain the outbreak and expressed his condolences for the lives lost. The leaders discussed ongoing mitigation measures, including those directed through the Monrovia-based U.S. Disaster Assistance Response Team and deployed personnel in both Liberia and Sierra Leone from the Centers for Disease Control and Prevention. The President further noted that, while their participation was missed, he appreciated President Sirleaf and President Koroma’s decisions to forgo last week’s U.S.-Africa Leaders Summit in Washington, D.C. to tend to the outbreak.

HHS SAYS MORE PHYSICIANS, HOSPITALS USING ELECTRONIC HEALTH RECORDS (EHRs)

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

More physicians and hospitals are using EHRs than before

CDC data provides baseline for EHR adoption among health care providers

Significant increases in the use of electronic health records (EHRs) among the nation’s physicians and hospitals are detailed in two new studies published today by the HHS Office of the National Coordinator for Health Information Technology (ONC).

The studies, published in the journal Health Affairs, found that in 2013, almost eight in ten (78 percent) office-based physicians reported they adopted some type of EHR system. About half of all physicians (48 percent) had an EHR system with advanced functionalities in 2013, a doubling of the adoption rate in 2009.

About 6 in 10 (59 percent) hospitals had adopted an EHR system with certain advanced functionalities in 2013, quadruple the percentage for 2010. Unlike the physician study, the hospital study does not have an equivalent, established measure of adoption of some type of EHR system; it only reports on adoption of EHRs with advanced functionalities.

“Patients are seeing the benefits of health IT as a result of the significant strides that have been made in the adoption and meaningful use of electronic health records,” said Karen DeSalvo, M.D., M.P.H., national coordinator for health information technology. “We look forward to working with our partners to ensure that people’s digital health information follows them across the care continuum so it will be there when it matters most.”

The information in the studies was collected by the Centers for Disease Control and Prevention’s National Center for Health Statistics and the American Hospital Association in 2013.

These data provide an early baseline understanding of provider readiness to achieve Stage 2 Meaningful Use of the Medicare and Medicaid EHR Incentive programs.  Stage 2 will begin later this year for providers who first attested to Stage 1 Meaningful Use in 2011 or 2012. About 75 percent of eligible professionals and more than 91 percent of hospitals have adopted or demonstrated Stage 1 Meaningful Use of certified EHRs.

The studies also show that more work is needed to support widespread health information exchange and providers’ ability to achieve Stage 2 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs. Among the details include the following:

In 2013, health information exchange among physicians was relatively low: 4 in 10 (39 percent) reported they electronically share data with other providers, but only 14 percent electronically share data with ambulatory care providers or hospitals outside their organization.
In 2013, the vast majority of hospitals had capabilities that could be used to support many Meaningful Use Stage 2 objectives but were not being used. However, 10 percent of hospitals were providing patients with online access to view, download, and transmit information about their hospital admission.
Throughout 2014, HHS has prioritized its efforts to support providers in achieving Meaningful Use Stage 2 and work toward an interoperable health system that enables nationwide health information exchange. These include:

On-the-ground support from many of the 62 ONC-funded regional extension centers to more than 150,000 providers that serve all types of patients, including Medicare, Medicaid, private pay, and uninsured, helping them use their EHRs to meet the Stage 2 measures such as those for clinical quality improvement, transitions of care, care coordination, and the privacy and security requirements;
Sharing tools and resources to support providers in engaging their patients in their health and health care using health IT tools, and to help meet the “view, download, and transmit measure” needed to achieve Meaningful Use Stage 2; and
Webinars, user guides, tip sheets, listserv subscriptions and other educational resources provided by the CMS eHealth University and available on the CMS website.

COMPANY TO PAY $18 MILLION FOR ALLEGED IMPROPER SETTINGS OF TEMP MONITORS FOR VACCINE SHIPMENTS

FROM:  U.S. JUSTICE DEPARTMENT 

Friday, August 8, 2014

McKesson Corp. to Pay $18 Million to Resolve False Claims Allegations Related to Shipping Services Provided Under Centers for Disease Control Vaccine Distribution Contract

McKesson Corporation has agreed to pay $18 million to resolve allegations that it improperly set temperature monitors used in shipping vaccines under its contract with the Centers for Disease Control and Prevention (CDC), the Justice Department announced today.  McKesson is a pharmaceutical distributor with corporate headquarters in San Francisco.

“Companies must comply with the requirements they agree to when they contract with the government to provide products that protect the public,” said Assistant Attorney General Stuart F. Delery for the Justice Department’s Civil Division.  “If a contractor does not adhere to the terms it negotiated, its conduct not only hurts taxpayers but also could jeopardize the integrity of products, like vaccines, that Americans count on to be safe.”

The government alleged that McKesson failed to comply with the shipping and handling requirements of its vaccine distribution contract with the CDC.  Under the contract, McKesson provided distribution services, receiving vaccines purchased by the government from manufacturers and then distributing the vaccines to health care providers.  The government alleged that the contract required McKesson to ensure that during shipping, the vaccines were maintained at proper temperatures by, among other things, including electronic temperature monitors set to detect when the air temperature in the box reached two degrees Celsius and below or eight degrees Celsius and above.  The government alleged that, from approximately April 2007 to November 2007, McKesson failed to set the monitors to the appropriate range, and as a result, knowingly submitted false claims to the CDC for shipping and handling services that did not satisfy its contractual obligations.

According to the CDC, redundant measures were and are used to ensure vaccines are kept at appropriate temperatures during shipping.  The most important of these were validated packing procedures used to maintain proper vaccine temperatures.  Temperature monitors provided a secondary safeguard. For more information about vaccine storage and handling, please visit the CDC website or contact the CDCs press office at 404-639-3286 and media@cdc.gov .

“Ensuring the integrity and performance of government contracts is paramount, especially when they impact programs intended to protect young children” said Derrick L. Jackson, special agent in charge of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) in Atlanta.  “Holding accountable those who fail to meet their obligations – thereby violating the trust of the American taxpayer -- continues to be a top OIG priority.”

The allegations resolved by today’s settlement were originally raised in a lawsuit filed against McKesson by Terrell Fox, a former finance director at McKesson Specialty Distribution LLC, under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens with knowledge of false claims to bring civil actions on behalf of the government and to share in any recovery.  Fox’s share of the settlement has not been determined.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $20.2 billion through False Claims Act cases, with more than $14 billion of that amount recovered in cases involving fraud against federal health care programs.

The case was handled by the Civil Division’s Commercial Litigation Branch and the U.S. Attorney’s Office for the Middle District of Tennessee, with assistance from HHS-OIG and Office of General Counsel.

The claims settled by this agreement are allegations only, and there has been no determination of liability.  The lawsuit is captioned United States ex rel. Fox v. McKesson Corp., No. 3:12-cv-00766 (M.D. Tenn.).

U.S. MILITARY ARE HELPING IN THE FIGHT AGAINST EBOLA OUTBREAK

FROM:  U.S. DEFENSE DEPARTMENT 

Military Responders Help Battle Ebola Outbreak

By Terri Moon Cronk and Cheryl Pellerin

DoD News, Defense Media Activity

WASHINGTON, Aug. 1, 2014 – Defense Department personnel are on the ground in West Africa and in U.S. laboratories fighting to control the worst outbreak in the African history of the Ebola virus, which a senior Army infectious disease doctor called a “scourge of mankind.”

Army Col. (Dr.) James Cummings, director of the Global Emerging Infections Surveillance and Response System, or GEIS, a division of the Armed Forces Health Surveillance Center, said the battle against the virus since the outbreak began in West Africa in March focuses on trying to stop disease transmission.
At the Centers for Disease Prevention and Control, or CDC, in Atlanta, Director Dr. Tom Frieden has announced that the health agency has raised the travel advisory to Liberia, Guinea and Sierra Leone where he said the Ebola outbreak is worsening, to Level 3 -- a warning to avoid unnecessary travel to those countries.
CDC already has disease detectives and other staff in those countries to track the epidemic, advise embassies, coordinate with the World Health Organization, or WHO, strengthen ministries of health, and improve case finding, contact tracing, infection control and health communication.

Over the next 30 days, in what Frieden described as a surge, CDC will send another 50 disease-control specialists into the three countries to help establish emergency operations centers and develop structured ways to address the outbreak.

“They will also help strengthen laboratory networks so testing for the disease can be done rapidly,” the director said.

For travelers in and out of the three West African countries, CDC experts will strengthen country capacity to monitor those who may have been exposed to Ebola, and each country in the region has committed to doing this, Frieden said.
“It's not easy to do,” he added, “but we will have experts from our division that do airport screening and try to ensure that people who shouldn't be traveling aren't traveling.”

Frieden said CDC has spoken with air carriers that service the West African region.

“We understand they will continue to fly, which is very important to continue to support the response and maintain essential functions in the country,” he explained.
CDC gives information to travelers to the region and health care providers in the United States who might care for people returning from the infected area. Frieden said that includes medical consultation and testing for patients who may have Ebola.

Frieden said that in the United States, “we are confident that we will not have significant spread of Ebola, even if we were to have a patient with Ebola here. We work actively to educate American health care workers on how to isolate patients and how to protect themselves against infection.”

In fact, he added, “any advanced hospital in the U.S., any hospital with an intensive care unit has the capacity to isolate patients. There is nothing particularly special about the isolation of an Ebola patient, other than it's really important to do it right. So ensuring that there is meticulous care of patients with suspected or … confirmed Ebola is what's critically important.”

The Ebola virus has no known cure and up to a 90 percent fatality rate and only supportive care can be offered to patients diagnosed with the disease while researchers work to find a vaccine.

DoD researchers think the viral disease originated in rural populations that prepare and eat meat from Ebola-carrying gorillas and monkeys.

The virus is passed among animals or people through body fluids. Only a person who is infected and is showing signs of illness can pass the disease to others.
Health care workers and home caretakers who have direct patient contact and those who prepare bodies for burial also are at risk, the infectious disease doctor said.

“We had a large footprint in Africa,” Cummings said of DoD’s response to the first Ebola cases reported in 1976 in the Democratic Republic of the Congo, formerly Zaire. Since that time, DoD has answered numerous calls for assistance from WHO, nongovernmental organizations and ministries of heath and defense, he explained.

DoD personnel provide a wide array of support to the Ebola-stricken African nations, from logistical help to guides for clinical management of the virus, Cummings said.

“DoD personnel bring a level of excellence second to none, working in response to host nations and WHO in the most-affected countries of Sierra Leone and Liberia,” he said.

DOJ RELEASES GUIDE TO REFORM HIV-SPECIFIC CRIMINAL LAWS TO ALIGN WITH SCIENCE

FROM:  U.S. JUSTICE DEPARTMENT 

Tuesday, July 15, 2014

Justice Department Releases Best Practices Guide to Reform HIV-Specific Criminal Laws to Align with Scientifically-Supported Factors

The Justice Department announced today that it has released a Best Practices Guide to Reform HIV-Specific Criminal Laws to Align with Scientifically-Supported Factors .  This guide provides technical assistance regarding state laws that criminalize engaging in certain behaviors without disclosing known HIV-positive status.   The guide will assist states to ensure that their policies reflect contemporary understanding of HIV transmission routes and associated benefits of treatment and do not place unnecessary burdens on individuals living with HIV/AIDS.

This guide is in follow-up to the department’s March 15, 2014, article published with the Centers for Disease Control and Prevention (CDC), Prevalence and Public Health Implications of State Laws that Criminalize Potential HIV Exposure in the United States, which examined HIV-specific criminal laws.  Generally, these laws do not account for scientifically-supported level of risk by type of activities engaged in or risk reduction measures undertaken.  As a result, many of these state laws criminalize behaviors that the CDC regards as posing either no risk or negligible risk for HIV transmission even in the absence of risk reduction measures.

“While initially well intentioned, these laws often run counter to current scientific evidence about routes of HIV transmission, and may run counter to our best public health practices for prevention and treatment of HIV,” said Acting Assistant Attorney General Jocelyn Samuels for the Civil Rights Division.  “The department is committed to using all of the tools available to address the stigma that acts as a barrier to effectively addressing this epidemic.”

The department’s efforts to provide guidance on HIV-specific criminal laws are part of its ongoing commitment to implementation of the National HIV/AID Strategy, released in 2010.  Today’s guide furthers the expectation from the Office of National AIDS Policy that we tackle misconceptions, stigma and discrimination to break down barriers to care for those people living with HIV in response to the President’s Executive Order last year on the HIV Care Continuum Initiative.

RESEARCHERS SAY NEW DEVICE WILL SAVE LIVES OF THOSE AFFLICTED WITH HEART FAILURE

FROM:  NATIONAL SCIENCE FOUNDATION 

A new tool for the early detection of heart failure

Researchers believe it will save lives and result in big savings to health care costs
Until recently, a reliable, low-cost, non-invasive method to measure changes that occur in the water content of the lungs did not exist. Yet, having such a device could be an important tool for the early detection of heart failure, which afflicts an estimated 5.1 million Americans and is a leading cause of hospitalization and death.

"There is a significant need," says Magdy Iskander, a professor of electrical engineering at the University of Hawaii at Manoa, and director of the Hawaii Center for Advanced Communications of the university's college of engineering, citing additional conditions that potentially could benefit from the new technology, including edema, emphysema, dehydration, blood infection, acute lung injury and the effects of critical burns.

"The impact could be tremendous, particularly for predicting heart failure," he says.

Heart failure costs the nation an estimated $32 billion annually, which includes the cost of health care services, medications to treat heart failure, and missed days of work, according to the federal Centers for Disease Control and Prevention. Furthermore, heart failure is a frequent reason patients are readmitted to hospitals within 30 days of their initial discharge.

"Annually more than one million patients are hospitalized due to heart failuree, which accounts for a total Medicare expenditure exceeding $17 billion," Iskander says.

The National Science Foundation (NSF)-funded scientist has invented a new type of stethoscope he believes will prompt significant and positive changes for patients suffering from heart failure and other related conditions. It attaches to the body surface much like an EKG sensor--there is no need to implant it--and uses a novel radio frequency (RF) sensor to detect small changes in lung water, and monitor vital signs including heart and respiration rate, and stroke volume. The device uses low level RF signals, two-thirds lower than the average cell phone signal, he says.

Since the lungs normally do contain some water, the idea is to first use the device to obtain a baseline in order to identify future changes, "before there are problems," he says. In hospitals, the stethoscope could be an important component of so-called "bridge clinics" that monitor patients after discharge to prevent readmission.

Under the Affordable Care Act, Medicare can reduce hospital payments for excessive readmissions. "Thus hospitals are motivated because now they are penalized when patients come back with heart failure within 30 days," he says.

He also envisions its use in "telemedicine," where an internet hookup will connect to a patient wearing the device, and will be able to measure important vital signs remotely, and transmit data on a regular basis, without having to go to the doctor or hospital in person, unless it is necessary.

"The most important thing is that we believe it will help save lives," Iskander adds. "But it also will almost certainly result in big savings in health care costs."

The cardio-pulmonary stethoscope evolved from research Iskander conducted years ago for the Air Force, when he was studying the effects of electromagnetic radiation on humans and developing safety standards for microwave exposure.

"We were trying to evaluate safe levels, and the biological effects of working with microwaves, and we were exploring the use of microwaves in medical applications," he says.

In doing so, he discovered that microwave signals reflect changes in lung water, forming the basis for his invention.

"If the lungs have too much water, the magnitude of the microwave signal is reduced because water absorbs microwaves," he says. "The more water, the weaker the signal."

NSF supported Iskander with a $50,000 Innovation Corps (I-Corps) grant, awarded in 2013, which supports a set of activities and programs that prepare scientists and engineers to extend their focus beyond the laboratory into the commercial world.

The goal of the I-Corps program is to help researchers translate their discoveries into technologies with near-term benefits for the economy and society. It is a public-private partnership program that teaches grantees to identify valuable product opportunities that can emerge from academic research, and offers entrepreneurship training to student participants.

Iskander recently formed a company, MiWa Technologies, which ultimately will manufacture and market the stethoscope. He has applied for patents, and is seeking additional funding for continuing research and to conduct clinical trials. A recent National Institutes of Health scientific review panel called the clinical significance of his work "very high," adding that the tool could "significantly impact the assessment and management of subjects with HF (Heart Failure) and respiratory failure."

Years ago, when he designed his first cardio-pulmonary stethoscope, he estimates that the components would have cost about $150,000 to build one instrument. Today, thanks to wireless technology and digital processing, the same components that go into manufacturing cell phones, his costs are but a fraction of that amount. Moreover, "the stethoscope actually is more accurate," he says.

-- Marlene Cimons, National Science Foundation
Investigators
Magdy Iskander
Nuri Celik
Zhengqing Yun
Marcelo Kobayashi

CDC STUDY SAYS CANCER SURVIVORS FACE LARGE FINANCIAL BURDEN

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

US cancer survivors face significant economic burden

Medical costs, health insurance access, and lost productivity have an impact
U.S. cancer survivors face significant economic burdens due to growing medical costs, missed work, and reduced productivity, according to a study by the Centers for Disease Control and Prevention in today’s Morbidity and Mortality Weekly Report.

 “Cancer survivors face physical, emotional, psycho-social, employment and financial challenges as a result of their cancer diagnosis and treatment,” said Donatus U. Ekwueme, PhD, a senior health economist at CDC’s Division of Cancer Prevention and Control. “With the number of cancer survivors expected to increase by more than 30 percent in the next decade – to 18 million Americans -- medical and public health professionals must be diligent in their efforts to help reduce the burden of cancer on survivors and their families.”
Researchers analyzed data from the Agency for Healthcare Research and Quality’s 2008-2011 Medical Expenditure Panel Survey to estimate annual medical costs and productivity losses among male and female cancer survivors, aged 18 years and older, and among persons without a cancer diagnosis. Lost productivity was estimated by reviewing employment disability (being unable to work because of illness or injury), health-related missed work days, and days spent in bed due to ill health.

From 2008-2011, male cancer survivors had annual medical costs of more than $8,000 per person, and productivity losses of $3,700 compared to males without a history of cancer at $3,900 and $2,300 respectively. During the same time, female cancer survivors had $8,400 in annual medical costs per person and $4,000 in productivity losses compared to females without a history of cancer at $5,100 and $2,700, respectively.

Study findings indicate:

Cancer survivors were more likely to be female, non-Hispanic white, have multiple chronic conditions, or to be in fair or poor health.

Employment disability accounted for about 75 percent of lost productivity among cancer survivors.

Among survivors who were employed at the time of their diagnosis, cancer and its treatment interfered with physical tasks (25 percent) and mental tasks required by the job (14 percent); almost 25 percent of cancer survivors felt less productive at work.

The report also found that about 10 percent of survivors aged 65 years and younger were uninsured and likely to have a larger financial burden compared to survivors with some source of payment for medical services. Through the Affordable Care Act, millions of Americans, including cancer survivors, have access to health coverage and preventive services.

The authors noted that nearly 32 percent of survivors experienced limitations in their usual daily activities outside of work because of cancer. Among those employed, more than 42 percent had to make changes to their work hours and duties. Comprehensive health and employment intervention programs may be needed to improve outcomes for cancer survivors and their families.

CDC WARNS PUBLIC ABOUT POOL CHEMICAL SAFETY

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Thousands Sent to Emergency Room by Preventable Pool Chemical Injuries

Children often the ones hurt by pool chemicals

Injuries from pool chemicals led to nearly 5,000 emergency room visits in 2012, according to a study released Thursday by the Centers for Disease Control and Prevention.

Nearly half of these preventable injuries were in children and teenagers and more than a third occurred at a home. Pool chemical injuries were most common during the summer swim season, from Memorial Day to Labor Day, and almost half occurred on weekends.

“Chemicals are added to the water in pools to stop germs from spreading. But they need to be handled and stored safely to avoid serious injuries,” said Michele Hlavsa, chief of CDC’s Healthy Swimming Program.

Residential pool owners and public pool operators can follow these simple and effective steps to prevent pool chemical injuries:

Read and follow directions on product labels.

Wear appropriate safety equipment, such as goggles and masks, as directed, when handling pool chemicals.

Secure pool chemicals to protect people and animals.

Keep young children away when handling chemicals.

NEVER mix different pool chemicals with each other, especially chlorine products with acid.

Pre-dissolve pool chemicals ONLY when directed by product label.
Add pool chemical to water, NEVER water to pool chemicals.

The study analyzed data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). NEISS captures data on injuries related to consumer products from about 100 hospital emergency departments nationwide. The NEISS data can then be used to calculate national estimates.

May 19–25, 2014 is Recreational Water Illness and Injury (RWII) Prevention Week. The theme for RWII Prevention Week 2014 is Healthy and Safe Swimming: We’re in it Together. It focuses on the role of swimmers, aquatics and beach staff, residential pool owners, and public health officials in preventing drowning, pool chemical injuries, and outbreaks of illnesses.

Chlorine and bromine do not kill germs instantly; most are killed within minutes. So it is important that everyone help keep germs out of the water in the first place by not swimming when ill with diarrhea and taking kids on bathroom breaks. Protect yourself by not swallowing pool water.

CDC REPORTS THAT DISABLED HAVE LESS ACTIVITY AND MORE CHRONIC DISEASE

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Inactivity Related to Chronic Disease in Adults with Disabilities
Half of adults with disability get no aerobic physical activity
Working age adults with disabilities who do not get any aerobic physical activity are 50 percent more likely than their active peers to have a chronic disease such as cancer, diabetes, stroke, or heart disease, according to a Vital Signs report released today by the Centers for Disease Control and Prevention (CDC).
Nearly half (47 percent) of adults with disabilities who are able to do aerobic physical activity do not get any. An additional 22 percent are not active enough. Yet only about 44 percent of adults with disabilities who saw a doctor in the past year got a recommendation for physical activity.

“Physical activity is the closest thing we have to a wonder drug,” said CDC Director Tom Frieden, M.D., M.P.H. “Unfortunately, many adults with disabilities don’t get regular physical activity.  That can change if doctors and other health care providers take a more active role helping their patients with disabilities develop a physical fitness plan that’s right for them.”

Most adults with disabilities are able to participate in some aerobic physical activity which has benefits for everyone by reducing the risk of serious chronic diseases. Some of the benefits from regular aerobic physical activity include increased heart and lung function; better performance in daily living activities; greater independence; decreased chances of developing chronic diseases; and improved mental health.

For this report, CDC analyzed data from the 2009-2012 National Health Interview Survey and focused on the relation between physical activity levels and chronic diseases among U.S. adults aged 18-64 years with disabilities, by disability status and type.  These are adults with serious difficulty walking or climbing stairs; hearing; seeing; or concentrating, remembering, or making decisions. Based on the 2010 data, the study also assessed the prevalence of receiving a health professional recommendation for physical activity and the association with the level of aerobic physical activity.

Key findings include:

Working age adults with disabilities are three times more likely to have heart disease, stroke, diabetes or cancer than adults without disabilities.
Nearly half of adults with disabilities get no aerobic physical activity, an important protective health behavior to help avoid these chronic diseases.
Inactive adults with disabilities were 50 percent more likely to report at least one chronic disease than were active adults with disabilities.
Adults with disabilities were 82 percent more likely to be physically active if their doctor recommended it.

The Physical Activity Guidelines for Americans recommend that all adults, including those with disabilities, get at least 150 minutes (2.5 hours) of moderate – intensity aerobic physical activity each week. If meeting these guidelines is not possible, adults with disabilities should start physical activity slowly based on their abilities and fitness level.

Doctors and other health professionals can recommend physical activity options that match the abilities of adults with disabilities and resources that can help overcome barriers to physical activity. These barriers include limited information about accessible facilities and programs; physical barriers in the built or natural environment; physical or emotional barriers to participating in fitness and recreation activities, and lack of training in accessibility and communication among fitness and recreation professionals.

“It is essential that we bring together adults with disabilities, health professionals and community leaders to address resource needs to increase physical activity for people with disabilities,” said Coleen Boyle, Ph.D., M.S. hyg., director of CDC’s National Center on Birth Defects and Developmental Disabilities.

CDC has set up a dedicated resource page for doctors and other health professionals with information to help them recommend physical activity to their adult patients with disabilities, www.cdc.gov/disabilities/PA.  

Through the Affordable Care Act, more Americans have access to health coverage and to no-cost preventive services. Most health insurance plans cannot deny, limit, or exclude coverage to anyone based on a pre-existing condition, including persons with disabilities. To learn more about the Affordable Care Act, visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325).

Vital Signs is a CDC report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report, or MMWR. The report provides the latest data and information on key health indicators. These are cancer prevention, obesity, tobacco use, motor vehicle passenger safety, prescription drug overdose, HIV/AIDS, alcohol use, health care-associated infections, cardiovascular health, teen pregnancy, food safety and developmental disabilities.

CDC SAYS UP TO 40 PERCENT OF DEATHS FROM 5 LEADING CAUSES ARE PREVENTABLE

FROM:  CENTERS OF DISEASE CONTROL AND PREVENTION 

Up to 40 percent of annual deaths from each of five leading US causes are preventable

Each year, nearly 900,000 Americans die prematurely from the five leading causes of death – yet 20 percent to 40 percent of the deaths from each cause could be prevented, according to a study from the Centers for Disease Control and Prevention.

The five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. Together they accounted for 63 percent of all U.S. deaths in 2010, with rates for each cause varying greatly from state to state.  The report, in this week’s issue of CDC’s weekly journal, Morbidity and Mortality Weekly Report, analyzed premature deaths (before age 80) from each cause for each state from 2008 to 2010. The authors then calculated the number of deaths from each cause that would have been prevented if all states had same death rate as the states with the lowest rates.
The study suggests that, if all states had the lowest death rate observed for each cause, it would be possible to prevent:

34 percent of premature deaths from heart diseases, prolonging about 92,000 lives
21 percent of premature cancer deaths, prolonging about 84,500 lives

39 percent of premature deaths from chronic lower respiratory diseases, prolonging about 29,000 lives

33 percent of premature stroke deaths, prolonging about 17,000 lives

39 percent of premature deaths from unintentional injuries, prolonging about 37,000 lives

“As a doctor, it is heartbreaking to lose just one patient to a preventable disease or injury – and it is that much more poignant as the director of the nation’s public health agency to know that far more than a hundred thousand deaths each year are preventable,” said Tom Frieden, MD, MPH. “With programs such as the CDC’s Million Hearts initiative, we are working hard to prevent many of these premature deaths.”

The numbers of preventable deaths from each cause cannot be added together to get an overall total, the authors note. That’s because prevention of some premature deaths may push people to different causes of death. For example, a person who avoids early death from heart disease still may die prematurely from another preventable cause, such as an unintentional injury.
Modifiable risk factors are largely responsible for each of the leading causes of death:
Heart disease risks include tobacco use, high blood pressure, high cholesterol, type 2 diabetes, poor diet, overweight, and lack of physical activity.

Cancer risks include tobacco use, poor diet, lack of physical activity, overweight, sun exposure, certain hormones, alcohol, some viruses and bacteria, ionizing radiation, and certain chemicals and other substances.

Chronic respiratory disease risks include tobacco smoke, second-hand smoke exposure, other indoor air pollutants, outdoor air pollutants, allergens, and exposure to occupational agents.

Stroke risks include high blood pressure, high cholesterol, heart disease, diabetes, overweight, previous stroke, tobacco use, alcohol use, and lack of physical activity.

Unintentional injury risks include lack of seatbelt use, lack of motorcycle helmet use, unsafe consumer products, drug and alcohol use (including prescription drug misuse), exposure to occupational hazards, and unsafe home and community environments.

Many of these risks are avoidable by making changes in personal behaviors. Others are due to disparities due to the social, demographic, environmental, economic, and geographic attributes of the neighborhoods in which people live and work. The study authors note that if health disparities were eliminated, as called for in Healthy People 2020External Web Site Icon, all states would be closer to achieving the lowest possible death rates for the leading causes of death.
”We think that this report can help states set goals for preventing premature death from the conditions that account for the majority of deaths in the United States,” said Harold W. Jaffe, MD, the study’s senior author and CDC’s associate director for science. “Achieving these goals could prolong the lives of tens of thousands of Americans.”

Southeastern states had the highest number of preventable deaths for each of the five causes. The study authors suggest that states with higher rates can look to states with similar populations, but better outcomes, to see what they are doing differently to address leading causes of death.

CDC SAYS FIVE MAJOR DIABETES-RELATED COMPLICATIONS HAVE DECLINED SUBSTANTIALLY

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION

CDC data show declines in some diabetes-related complications among US adults
Despite progress continued efforts needed to combat diabetes complications
Rates of five major diabetes-related complications have declined substantially in the last 20 years among U.S. adults with diabetes, according to a study by the Centers for Disease Control and Prevention, published in the current issue of the New England Journal of Medicine.

Rates of lower-limb amputation, end-stage kidney failure, heart attack, stroke, and deaths due to high blood sugar (hyperglycemia) all declined.  Cardiovascular complications and  deaths from high blood sugar decreased by more than 60 percent each, while the rates of both strokes and lower extremity amputations – including upper and lower legs, ankles, feet, and toes – declined by about half.  Rates for end stage kidney failure fell by about 30 percent.

“These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, Ph.D., a senior epidemiologist in CDC’s Division of Diabetes Translation and lead author of the study. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.”

Because the number of adults reporting diabetes during this time frame more than tripled – from 6.5 million to 20.7 million – these major diabetes complications continue to put a heavy burden on the U.S. health care system.  Nearly 26 million Americans have diabetes and an additional 79 million have prediabetes and are at risk of developing the disease.  Diabetes and its complications account for $176 billion in total medical costs each year.

CDC researchers used data from the National Health Interview Survey, National Hospital Discharge Survey, U.S. Renal Data System, and Vital Statistics, to examine trends in the occurrence of diabetes-related complications in the United States between 1990 and 2010.

Although all complications declined, the greatest declines in diabetes-related complications occurred for heart attack and stroke, particularly among people aged 75 years and older. The study authors attribute the declines in diabetes-related complications to increased availability of health care services, risk factor control, and increases in awareness of the potential complications of diabetes.

CDC REPORTS ON WAYS TO REDUCE HEALTH DISPARITIES AMONG DIVERSE POPULATIONS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

CDC Reports on Effective Strategies for Reducing Health Disparities

Public health interventions close health equity gaps among diverse U.S. populations

Evidence-based interventions at the local and national levels provide promising strategies for reducing racial and ethnic health disparities related to HIV infection rates, immunization coverage, motor vehicle injuries and deaths, and smoking, according to a new report by the CDC’s Office of Minority Health and Health Equity.

The report,published today as an MMWR Supplement, describes CDC-led programs addressing some of the health disparities previously highlighted in the CDC Health Disparities and Inequalities Reports, CHDIR, 2011 and 2013. The CHDIR reports highlight 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.
“Reducing and eliminating health disparities is central to achieving the highest level of health for all people,” said CDC Director Tom Frieden, M.D., M.P.H.  “We can close the gap when it comes to health disparities if we monitor the problem effectively and ensure that there is equal access to all proven interventions.”

Examples of the programs and health disparities addressed:
The Vaccines for Children (VFC) Program, managed by CDC, provides vaccines at no cost to eligible children who might otherwise not be vaccinated because of inability to pay. After the introduction of the VFC Program, racial/ethnic disparities in childhood immunization coverage do not exist for measles-mumps-rubella and poliovirus vaccines.

Many Men, Many Voices (3MV) is an evidence-based HIV/STD prevention intervention developed by and for black men who have sex with men (MSM) that can lead to decreased rates of HIV infection and increased access to preventive services and treatment among MSM of color. It uses small group education and interaction to increase knowledge and change attitudes and behaviors related to HIV/STD risk among black MSM.  In a randomized clinical trial, 3MV reduced participants’ high-risk sexual activity and increased rates of HIV testing. The program has been implemented in 37 states, the District of Columbia, and Puerto Rico and has been adapted to serve other MSM of color.

Four American Indian/Alaska Native tribal communities implemented tribal motor vehicle injury prevention programs, using evidence-based road safety interventions to reduce motor vehicle-related injuries and deaths. Each tribal community showed increased use of seat belts and child safety seats, increased enforcement of alcohol-impaired driving laws, or decreased motor vehicle crashes involving injuries or deaths. The effective use of communication tools –billboards, radio and television media campaigns, and school and community education programs– contributed to the success of this public health program.
“These interventions demonstrate progress toward health equity. They show the elimination of health disparities as an achievable goal and encourage further implementation of evidence-based initiatives and interventions addressing health disparities and inequities,” said Leandris C. Liburd, Ph.D., M.P.H., M.A., CDC’s associate director for Minority Health and Health Equity.

The release of this supplement coincides with 2014 National Minority Health Month, which raises awareness about the health disparities that continue to affect racial and ethnic minorities across the United States.

MORE CASES OF HEARTLAND VIRUS IDENTIFIED

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION  
CDC Reports More Cases of Heartland Virus Disease
New virus infects six more people and found in second state

The Centers for Disease Control and Prevention (CDC) in collaboration with health officials in Missouri and Tennessee have identified six new cases of people sick with Heartland virus: five in Missouri and one in Tennessee. The new cases, discovered in 2012 and 2013, are in addition to two discovered in 2009 and are described today in CDC’s Morbidity and Mortality Weekly Report.

Heartland virus was first reported in two northwestern Missouri farmers who were hospitalized in 2009 with what was thought to be ehrlichiosis, a tick-borne disease. However, the patients failed to improve with treatment and testing failed to confirm ehlrlichiosis. Working with state and local partners, CDC eventually identified the cause of the men’s illness: a previously unknown virus in the phlebovirus family now dubbed Heartland virus.

Ongoing investigations have yielded six more cases of Heartland virus disease, bringing to eight the total number of known cases. All of the case-patients were white men over the age of 50. Their symptoms started in May to September and included fever, fatigue, loss of appetite, headache, nausea, or muscle pain. Four of the six new cases were hospitalized. One patient, who suffered from other health conditions, died. It is not known if Heartland virus was the cause of death or how much it contributed to his death. Five of the six new cases reported tick bites in the days or weeks before they fell ill.

Nearly all of the newly reported cases were discovered through a study conducted by the Missouri Department of Health and Senior Services and CDC are actively searching for human cases at six Missouri hospitals.

CDC has been working closely with the Missouri and Tennessee state health departments and other federal agencies to advance understanding of Heartland virus disease by learning more about the patients who were infected, their illness and their exposure to ticks. CDC seeks to determine the symptoms and severity of the disease, where it is found, how people are being infected, and how to prevent infections.

CDC studies to date have shown Heartland virus is carried by Lone Star ticks, which are primarily found in the southeastern and eastern United States. Additional studies seek to confirm whether ticks can spread the virus to people and to learn what other insects or animals may be involved in the transmission cycle. CDC is also looking for Heartland virus in other parts of the country to understand how widely it may be distributed.

“During the past two years, CDC has worked closely with state health departments, hospitals, and many experts from universities and other federal agencies to learn more about Heartland virus,” said Roger Nasci, Ph.D., chief of CDC’s Arboviral Diseases Branch. “By gathering information about the disease Heartland virus causes, and about how it’s spread to people, we hope to better understand the potential impact on the public’s health and how we can help protect people from this virus CDC developed the blood tests used to confirm the new cases of Heartland virus disease. CDC teams are working to further validate these tests and develop additional tests. As more is learned, CDC hopefully can develop a diagnostic test that public health laboratories could use to test for the virus.

There is no specific treatment, vaccine or drug for Heartland virus disease. Because it is caused by a virus, the disease also does not respond to antibiotics used to treat tickborne bacterial infections such as Lyme disease. However, supportive therapies such as IV fluids and fever reducers can relieve some Heartland disease symptoms.

To reduce the risk of Heartland and other vector-borne diseases, CDC recommends that people:
Avoid wooded and bushy areas with high grass and leaf litter;
Use insect repellent when outdoors;
Use products that contain permethrin on clothing;
Bathe or shower as soon as possible after coming indoors to wash off and more easily find ticks that are crawling on you;
Conduct a full-body tick check after spending time outdoors; and
Examine gear and pets, as ticks can “ride” into the home and attach to a person later.

CDC SAYS STUDY SHOWS FLU VACCINE REDUCED CHILDREN'S FLU INTENSIVE CARE ADMISSIONS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

New Study Shows Flu Vaccine Reduced Children’s Risk of Intensive Care Unit Flu Admission by Three-Fourths

Getting a flu vaccine reduces a child’s risk of flu-related intensive care hospitalization by 74 percent, according to a CDC study published today in the Journal of Infectious DiseasesExternal Web Site Icon.

The study is the first to estimate vaccine effectiveness (VE) against flu admissions to pediatric intensive care units (PICU). It illustrates the important protection flu vaccine can provide to children against more serious flu outcomes. CDC recommends annual flu vaccination for everyone 6 months and older and especially for children at high risk of serious flu-related complications.
“These study results underscore the importance of an annual flu vaccination, which can keep your child from ending up in the intensive care unit,” said Dr. Alicia Fry, a medical officer in CDC’s Influenza Division. “It is extremely important that all children – especially children at high risk of flu complications – are protected from what can be a life-threatening illness."

Children younger than 5 years and children of any age with certain chronic medical conditions like asthma, diabetes or developmental delays, are at high risk of serious flu complications.

Fry’s team analyzed the medical records of 216 children age 6 months through 17 years admitted to 21 PICUs in the United States during the 2010-2011 and 2011-2012 flu seasons. They found that flu vaccination reduced a child's risk of ending up in the pediatric intensive care unit for flu by an estimated 74 percent. These findings show that while vaccination may not always prevent flu illness, it protects against more serious outcomes.

Though flu vaccination was associated with a significant reduction in risk of PICU admission, flu vaccine coverage was relatively low among the children in this study: only 18 percent of flu cases admitted to the ICU had been fully vaccinated.
More than half (55 percent) of cases had at least one underlying chronic medical condition that placed them at higher risk of serious flu-related complications.
CDC usually measures flu VE against “medically attended flu illness” – that is, how well it protects against having to go to the doctor for flu symptoms. During the 2010-2011 and 2011-2012 seasons, the midpoint VE estimates against medically attended illness were 60 percent and 47 percent respectively.

"Because some people who get vaccinated may still get sick, it's important to remember to use our second line of defense against flu: antiviral drugs to treat flu illness,” Fry said. “People at high risk of complications should seek treatment if they get a flu-like illness. Their doctors may prescribe antiviral drugs if it looks like they have influenza."

Symptoms of flu may include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and sometimes diarrhea and vomiting.

Flu causes hospitalizations in children each season, but how many children are affected varies, depending on the severity of the season. CDC estimates that 20,000 children younger than 5 years are hospitalized on average each year. For children younger than 18 years, published studies suggest an annual range of flu-related hospitalization rates of between one child and seven children per 10,000 children. Between 4 percent and 24 percent of hospitalized children require PICU admission.

REPORTS RELEASED ON DISEASES THREATENING HOSPITAL PATIENTS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Despite Progress, Ongoing Efforts Needed to Combat Infections Impacting Hospital Patients

National and state data detail threat of healthcare-associated infections and opportunities for further improvements

On any given day, approximately one in 25 U.S. patients has at least one infection contracted during the course of their hospital care, adding up to about 722,000 infections in 2011, according to new data from the Centers for Disease Control and Prevention. This information is an update to previous CDC estimates of healthcare-associated infections.

The agency released two reports today – one, a New England Journal of MedicineExternal Web Site Icon article detailing 2011 national healthcare-associated infection estimates from a survey of hospitals in ten states, and the other a 2012 annual report on national and state-specific progress toward U.S. Health and Human Services HAI prevention goalsExternal Web Site Icon. Together, the reports show that progress has been made in the effort to eliminate infections that commonly threaten hospital patients, but more work is needed to improve patient safety.

"Although there has been some progress, today and every day, more than 200 Americans with healthcare-associated infections will die during their hospital stay,” said CDC Director Tom Frieden, M.D., M.P.H.  “The most advanced medical care won’t work if clinicians don’t prevent infections through basic things such as regular hand hygiene.  Health care workers want the best for their patients; following standard infection control practices every time will help ensure their patients’ safety."

The CDC Multistate Point-Prevalence Survey of Health Care-Associated Infections, published in NEJM, used 2011 data from 183 U.S. hospitals to estimate the burden of a wide range of infections in hospital patients. That year, about 721,800 infections occurred in 648,000 hospital patients.  About 75,000 patients with healthcare-associated infections died during their hospitalizations. The most common healthcare-associated infections were pneumonia (22 percent), surgical site infections (22 percent), gastrointestinal infections (17 percent), urinary tract infections (13 percent), and bloodstream infections (10 percent).

The most common germs causing healthcare-associated infections were C. difficile (12 percent), Staphylococcus aureus, including MRSA (11 percent), Klebsiella (10 percent), E. coli (9 percent), Enterococcus (9 percent), and Pseudomonas (7 percent).  Klebsiella and E. coli are members of the Enterobacteriaceae bacteria family, which has become increasingly resistant to last-resort antibiotics known as carbapenems.

 Tracking National Progress

The second report, CDC’s National and State Healthcare-associated Infection Progress Report, includes a subset of infection types that are commonly required to be reported to CDC.  On the national level, the report found a:
44 percent decrease in central line-associated bloodstream infections between 2008 and 2012

20 percent decrease in infections related to the 10 surgical procedures tracked in the report between 2008 and 2012

four percent decrease in hospital-onset MRSA between 2011 and 2012
two percent decrease in hospital-onset C. difficile infections between 2011 and 2012

“Our nation is making progress in preventing healthcare-associated infections through three main mechanisms: financial incentives to improve quality, performance measures and public reporting to improve transparency, and the spreading and scaling of effective interventions,” said Patrick Conway, M.D.,External Web Site Icon Deputy Administrator for Innovation and Quality for Centers for Medicare & Medicaid Services (CMS) and CMS chief medical officer. “This progress represents thousands of lives saved, prevented patient harm, and the associated reduction in costs across our nation.”
The federal government considers elimination of health care-associated infections a top priority and has a number of ongoing efforts to protect patients and improve health care quality. In addition to CDC’s expertise and leadership in publishing evidence-based infection prevention guidelines, housing the nation’s healthcare-associated infection laboratories, responding to health care facility outbreaks and tracking infections in these facilities, other federal and non-federal partners are actively working to accelerate the prevention progress that is happening across the country.  These initiatives are coordinated through the National Action Plan to Prevent Healthcare-Associated Infections and include CMS’ Partnership for PatientsExternal Web Site Icon, CMS Quality Improvement OrganizationsExternal Web Site Icon, and the Agency for Healthcare Research and Quality’sExternal Web Site Icon Comprehensive Unit-based Safety ProgramExternal Web Site Icon.

State Data

The Progress Report looked at data submitted to CDC’s National Healthcare Safety Network (NHSN), the nation’s healthcare-associated infection tracking system, which is used by more than 12,600 health care facilities across all 50 states, Washington, D.C., and Puerto Rico. Not all states reported or had enough data to calculate valid infection information on every infection in this report. The number of infections reported was compared to a national baseline.
In the report, none of the 50 states, Washington, D.C., or Puerto Rico performed better than the nation on all four infection types tracked by state (CLABSI, CAUTI, and infections after colon surgery and abdominal hysterectomy).  Sixteen states performed better than the nation on two infections, including two states performing better on three infections.  In addition, 16 states performed worse than the nation on two infections, with seven states performing worse on at least three infections.  
FY15 President’s Budget

Expanding upon current patient safety goals, the FY 2015 President’s Budget requests funding for CDC to increase the detection of antibiotic resistant infections and improve efforts to protect patients from infections, including those detailed in today’s CDC reports.  Additionally the President’s Budget requests an increase for the National Healthcare Safety Network to fully implement tracking of antibiotic use and antibiotic resistance threats in U.S. hospitals.

U.S. TUBERCULOSIS TRENDS

FROM CENTERS FOR DISEASE CONTROL AND PREVENTION

1. Trends in Tuberculosis — United States, 2013

Data indicate that cases and rates of TB disease continue to fall in the U.S.; however, a higher burden in some populations – such as foreign-born individuals and racial/ethnic minorities – keeps TB elimination out of reach. Preliminary data from the CDC National TB Surveillance System show a total of 9,588 cases were reported in the U.S. in 2013, marking a 4.2 percent decline in the 2012 rate (from 3.2 to 3.0 cases per 100,000 population). Despite overall progress, the TB rate for foreign-born individuals is 13 times higher than among individuals born in the U.S., and the proportion of TB cases in the foreign-born group continues to increase. Racial disparities persist. Hispanics, blacks and Asians face higher TB rates—7, 7 and 26 times higher, respectively—than whites. Persons infected with HIV and people who are homeless are also especially vulnerable to TB. Although the proportion of drug-resistant cases remains relatively small, drug resistant TB is a concern because it is difficult and costly to treat and more often fatal. In 2012, multidrug-resistant TB accounted for 1.2 percent of cases (86 cases). Two cases of extensively-drug-resistant TB were reported in 2013. The authors note that eliminating TB in the U.S. requires continuing to address TB in affected populations and improvements in awareness, testing and treatment of TB disease.

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

Updated CDC recommendations for overseas tuberculosis screening of immigrants and refugees has resulted in better diagnosis of TB before individuals arrive in the United States. CDC reports the completion of implementation of new tuberculosis screening and treatment requirements for US-bound immigrants and refugees. Implementation of these requirements has resulted in twice as many cases of tuberculosis being diagnosed and treated before immigrants and refugees arrive in the U.S. compared with the previous screening program. Since the new requirements were implemented, reports of cases of foreign-born tuberculosis have declined. In addition, the increase in persons diagnosed and treated overseas is projected to result in a savings of more than $15 million in US health care costs.

UPDATE: MENINGOCOCCAL DISEASE

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 

Meningococcal Disease Update

On Monday, March 10, a Drexel University student tragically died from serogroup B meningococcal disease. CDC’s laboratory analysis shows that the strain in Princeton University’s serogroup B meningococcal disease outbreak matches the strain in the Drexel University case by “genetic fingerprinting.” This information suggests that the outbreak strain may still be present in the Princeton University community and we need to be vigilant for additional cases.

As with all cases of meningococcal disease, the local health department quickly and thoroughly investigated who has been in close contact with the Drexel University student prior to illness onset. Antibiotic prophylaxis to prevent additional cases of meningococcal disease was recommended and administered to those who had or may have had close contact. To date, no related cases among Drexel University students have been reported.

The public health investigation of the Drexel University student revealed that the student had been in close contact with students from Princeton University about a week before becoming ill. Princeton University has been experiencing a serogroup B meningococcal disease outbreak.

A high percentage of Princeton University undergraduates and eligible graduate students received 2 doses of the investigational serogroup B vaccine as part of a recent vaccination effort at Princeton University. There are currently no serogroup B vaccines licensed (approved) in the United States. Those who have received the investigational vaccine have likely protected themselves from getting sick (there have been no new cases among Princeton University students since the vaccination campaign began on December 9, 2013). Available data show most adolescents that get 2 doses of this vaccine are protected from getting meningococcal disease. However, vaccinated individuals may still be able to carry the bacteria in their throats, which could infect others through close contact.

The local health department and Drexel University are taking all the recommended steps to prevent additional cases. Because Drexel University is not experiencing an outbreak of serogroup B meningococcal disease, members of that community are not considered to be at increased risk.  The investigational serogroup B vaccine is not currently available to the Drexel University community.

We will continue to closely monitor the situation and determine next steps while local health authorities remain vigilant to recognizing and promptly treating any new cases. At this time, CDC does not recommend limiting social interactions or canceling travel plans as a preventive measure for meningococcal disease.

We recognize that when cases of meningococcal disease occur, there is increased concern about the potential spread of disease and desire to take appropriate steps to prevent additional cases. There is no evidence that family members and the community are at increased risk of getting meningococcal disease from casual contact with Princeton University students, faculty, or staff. Although transmission is from person-to-person, this organism is not highly contagious and requires sharing respiratory and oral secretions to spread. Those at highest risk for disease are people who have had close, prolonged, or face-to-face contact with someone who has meningococcal disease.

Students at both Universities should be especially vigilant to the signs and symptoms of meningococcal disease and seek urgent treatment if suspected. Symptoms may include sudden onset of a high fever, headache, stiff neck, nausea, vomiting, rapid breathing, or a rash. Handwashing and covering coughs and sneezes are also good practices to follow.

ANTIBIOTICS LINKED TO CHILDREN'S DIARRHEA

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Severe diarrheal illness in children linked to antibiotics prescribed in doctor’s offices

CDC urges physicians to improve prescribing practices to reduce harm
The majority of pediatric Clostridium difficile infections, which are bacterial infections that cause severe diarrhea and are potentially life-threatening, occur among children in the general community who recently took antibiotics prescribed in doctor’s offices for other conditions, according to a new study by the Centers for Disease Control and Prevention published this week in Pediatrics.
The study showed that 71 percent of the cases of C. difficile infection identified among children aged 1 through 17 years were community-associated—that is, not associated with an overnight stay in a healthcare facility.  By contrast, two-thirds of C. difficile infections in adults are associated with hospital stays.
Among the community-associated pediatric cases whose parents were interviewed, 73 percent were prescribed antibiotics during the 12 weeks prior to their illness, usually in an outpatient setting such as a doctor’s office.  Most of the children who received antibiotics were being treated for ear, sinus, or upper respiratory infections. Previous studies show that at least 50 percent of antibiotics prescribed in doctor’s offices for children are for respiratory infections, most of which do not require antibiotics.

Improved antibiotic prescribing is critical to protect the health of our nation’s children,” said CDC Director Tom Frieden, M.D., M.P.H.  “When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including C. difficile infection and dangerous antibiotic resistant infections.”
he FY 2015 President’s Budget requests funding for CDC to improve outpatient antibiotic prescribing practices and protect patients from infections, such as those caused by C. difficile.  The CDC initiative aims to reduce outpatient prescribing by up to 20 percent and healthcare-associated C. difficile infections by 50 percent in five years.  A 50 percent reduction in healthcare-associated C. difficile infections could save 20,000 lives, prevent 150,000 hospitalizations, and cut more than $2 billion in healthcare costs.

C. difficile, which causes at least 250,000 infections in hospitalized patients and 14,000 deaths every year among children and adults, remains at all-time high levels.  According to preliminary CDC data, an estimated 17,000 children aged 1 through 17 years get C. difficile infections every year.  The Pediatrics study found that there was no difference in the incidence of C. difficile infection among boys and girls, and that the highest numbers were seen in white children and those between the ages of 12 and 23 months.

Taking antibiotics is the most important risk factor for developing C. difficile infections for both adults and children.  When a person takes antibiotics, beneficial bacteria that protect against infection can be altered or even eliminated for several weeks to months. During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a health care provider’s hands.
Although there have been significant improvements in antibiotic prescribing for certain acute respiratory infections in children, further improvement is greatly needed.  In addition, it is critical that parents avoid asking doctors to prescribe antibiotics for their children and that doctors follow prescribing guidelines.
“As both a doctor and a mom, I know how difficult it is to see your child suffer with something like an ear infection,” said Lauri Hicks, DO, Adobe PDF file director of CDC’s Get Smart: Know When Antibiotics Work program. “Antibiotics aren’t always the answer. I urge parents to work with their child’s doctor to find the best treatment for the illness, which may just be providing symptom relief.”

INFLUENZA ACTIVITY AND VACCINE EFFECTIVENESS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
1. Interim Estimates of 2013–14 Seasonal Influenza Vaccine Effectiveness — United States, February 2014

This season’s influenza vaccine reduced the risk for influenza-associated medical visits by approximately 60 percent across all age groups. Children at least 6 months old and older who have not yet received the 2013–14 influenza vaccine should be vaccinated. CDC recommends yearly flu vaccination for children 6 months old or older and adults. Because flu viruses change from season to season, CDC conducts studies each year to determine how well the flu vaccine works against the specific flu viruses that are circulating. This mid-season report presents data on 2,319 children and adults enrolled in the U.S. Flu Vaccine Effectiveness Network from December 2, 2013 to January 23, 2014. The study found that getting flu vaccine this season reduced the risk of flu-related doctor’s visits by 61 percent for all age groups. Influenza vaccination offered substantial protection against the flu virus circulating this season, pH1N1, and the same virus that emerged in 2009 and spread in a worldwide pandemic.

2. Update: Influenza Activity — United States, September 29, 2013–February 8, 2014

This influenza season, characterized as a pH1N1 season, has been more severe for young and middle-aged adults than in the most recent seasons. This is a reminder that influenza can cause severe illness in people of any age and that everyone aged 6 months and older should be vaccinated. When people do get the flu, antiviral treatment can reduce severe outcomes, especially when administered early. Influenza activity in the United States began increasing in mid-November and remained elevated as of February 8; elevated activity will likely continue for several more weeks. Surveillance data provide a reminder that while some age groups are at increased risk of influenza complications every year, influenza can cause severe illness in persons of any age, even in adults 18–64 years.CDC recommends that health-care providers continue to offer vaccine to all unvaccinated persons ≥6 months now and throughout the season.

CDC SAYS FLU SEASON HARD FOR YOUNGER PEOPLE

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
CDC Reports Flu Hit Younger People Particularly Hard This Season
Vaccination lowered risk of having to go to the doctor by about 60 percent for people of all ages

This influenza season was particularly hard on younger- and middle-age adults, the Centers for Disease Control and Prevention reported in today’s Morbidity and Mortality Weekly Report. People age 18-64 represented 61 percent of all hospitalizations from influenza—up from the previous three seasons when this age group represented only about 35 percent of all such hospitalizations. Influenza deaths followed the same pattern; more deaths than usual occurred in this younger age group.

A second report in this week’s MMWR showed that influenza vaccination offered substantial protection against the flu this season, reducing a vaccinated person’s risk of having to go to the doctor for flu illness by about 60 percent across all ages.
“Flu hospitalizations and deaths in people younger- and middle-aged adults is a sad and difficult reminder that flu can be serious for anyone, not just the very young and old; and that everyone should be vaccinated,” said CDC Director Tom Frieden, M.D., M.P.H. “The good news is that this season's vaccine is doing its job, protecting people across all age groups."

U.S. flu surveillance data suggests that flu activity is likely to continue for a number of weeks, especially in places where activity started later in the season. Some states that saw earlier increases in flu activity are now seeing decreases. Other states are still seeing high levels of flu activity or continued increases in activity.

While flu is responsible for serious illness and death every season, the people who are most affected can vary by season and by the predominant influenza virus. The currently circulating H1N1 virus emerged in 2009 to trigger a pandemic, which was notable for high rates of hospitalization and death in younger- and middle-aged people. While H1N1 viruses have continued to circulate since the pandemic, this is the first season since the pandemic they have been predominant in the U.S. Once again, the virus is causing severe illness in younger- and middle-aged people.

Approximately 61 percent of flu hospitalizations so far this season have occurred among persons aged 18-64 years. Last season, when influenza A (H3N2) viruses were the predominant circulating viruses, people 18 to 64 years accounted for only 35 percent of hospitalizations. During the pandemic season of 2009-2010, people 18 to 64 years old accounted for about 56 percent of hospitalizations.
Hospitalization rates have also been affected. While rates are still highest among people 65 and older (50.9 per 100,000), people 50 to 64 years now have the second-highest hospitalization rate (38.7 per 100,000), followed by children 0-4 years old (35.9 per 100,000). During the pandemic, people 50 to 64 years also had the second-highest hospitalization rate. Note that hospitalization rates are cumulative and thus will continue to increase this season.

Influenza deaths this season are following a pattern a similar to the pandemic.  People 25 years to 64 years of age have accounted for about 60 percent of flu deaths this season compared with 18 percent, 30 percent, and 47 percent for the three previous seasons, respectively. During 2009-2010, people 25 years to 64 years accounted for an estimated 63 percent of deaths.

"Younger people may feel that influenza is not a threat to them, but this season underscores that flu can be a serious disease for anyone," said Dr. Frieden. "It's important that everyone get vaccinated. It's also important to remember that some people who get vaccinated may still get sick, and we need to use our second line of defense against flu: antiviral drugs to treat flu illness. People at high risk of complications should seek treatment if they get a flu-like illness. Their doctors may prescribe antiviral drugs if it looks like they have influenza."

People at high risk for flu complications include pregnant women, people with asthma, diabetes or heart disease, people who are morbidly obese and people older than 65 or children younger than 5 years, but especially those younger than 2 years. A full list of high risk factors and antiviral treatment guidance is available on the CDC website. More information about flu vaccine and how well it works also is available.

Flu Vaccine Best Tool Available

In the flu vaccine effectiveness (VE) study, CDC looked at data from 2,319 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness (Flu VE) Network from December 2, 2013 to January 23, 2014. They found that flu vaccine reduced the risk of having to go to the doctor for flu illness by an estimated 61 percent across all ages. The study also looked at VE by age group and found that the vaccine provided similar levels of protection against influenza infection across all ages. VE point estimates against influenza A and B viruses by age group ranged from 52 percent for people 65 and older to 67 percent for children 6 months to 17 years. Protection against the predominant H1N1 virus was even slightly better for older people; VE against H1N1 was estimated to be 56 percent in people 65 and older and 62 percent in people 50 to 64 years of age. All findings were statistically significant.

The interim VE estimates this season are comparable to results from studies during other seasons when the viruses in the vaccine have been well-matched with circulating influenza viruses and are similar to interim estimates from Canada for 2013-14 published recently.

While flu vaccine can vary in how well it works, vaccination offers the best protection currently available against influenza infection. CDC recommends that everyone 6 months and older get an annual flu vaccine.

“We are committed to the development of better flu vaccines, but existing flu vaccines are the best preventive tool available now. This season vaccinated people were substantially better off than people who did not get vaccinated. The season is still ongoing. If you haven’t yet, you should still get vaccinated," said Dr. Frieden.