CDC WARNS THAT HPV VACCINE IS UNDERUTILIZED IN GIRLS AGED 13-17

FROM:  CENTERS FOR DISEASE CONTROL
HPV vaccine: Safe, effective, and grossly underutilized

In a press conference held today, top officials from CDC and the American Academy of Pediatrics announced that HPV vaccination rates in girls aged 13-17 years failed to increase between 2011 and 2012, according to data from the Centers for Disease Control and Prevention (CDC). Three-dose coverage actually declined slightly from 2011 to 2012.

The article in CDC's Morbidity and Mortality Weekly Report (MMWR) drew on data from the 2012 National Immunization Survey-Teen (NIS-Teen).
Among girls unvaccinated for HPV, 84 percent had a healthcare visit where they received another vaccine (such as one aimed at meningitis or pertussis) but not HPV vaccine. If HPV vaccine had been administered, vaccination coverage for ≥1 dose could be nearly 93 percent rather than 54 percent.

"Progress increasing HPV vaccination has stalled, risking the health of the next generation.," said CDC Director Tom Frieden M.D., M.P.H. "Doctors need to step up their efforts by talking to parents about the importance of HPV vaccine just as they do other vaccines and ensure its given at every opportunity."

According to CDC, for each year the 3-dose HPV vaccine series coverage remains near the current level of 33 perccent instead of achieving the Healthy People 2020 goal of 80 percent coverage, an additional 4,400 women will be diagnosed with cervical cancer and 1,400 cervical cancer-attributable deaths will occur in the future.

The 2012 NIS-Teen data show that not receiving a healthcare provider's recommendation for HPV vaccine was one of the five main reasons parents reported for not vaccinating daughters. Healthcare providers are urged to give a strong recommendation for HPV vaccination for boys and girls aged 11 or 12 years.

The other responses parents provided indicate gaps in understanding about the vaccine, including why vaccination is recommended at ages 11 or 12.
"Parents need reassurance that HPV vaccine is recommended at 11 or 12 because it should be given well in advance of any sexual activity," said Dr. Frieden. "We don't wait for exposure to occur before we vaccinate with any other routinely recommended vaccine."
Parents also reported safety concerns as a reason for not vaccinating. In the seven years of post-licensure vaccine safety monitoring and evaluation conducted independently by federal agencies and vaccine manufacturers, no serious safety concerns have been identified. According to today's MMWR article, reports of adverse events after HPV vaccination to the Vaccine
Adverse Event Reporting System (VAERS) have steadily decreased from 2008 to 2012 and the numbers of serious adverse events reported has also declined since 2009.

Approximately 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that nearly all sexually-active men and women will get at least one type of HPV at some point in their lives.

Parents and caregivers are encouraged to ask about vaccination every time they take children for a healthcare visit. If a preteen boy or girl (aged 11 or 12 years) has not started the HPV vaccine series, make an appointment to get him or her vaccinated. Teens who haven't started or finished the 3-dose series should do so—it's not too late for them to receive HPV vaccine.

For many, it's easier than ever to get the HPV vaccine. Because of the Affordable Care Act, most private health insurance plans must cover the HPV vaccine at no out-of-pocket cost, meaning no co-pay or deductible. Visit https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3External Web Site Icon for more information.

CDC officials urge healthcare providers to increase the consistency and strength of how they recommend HPV vaccine, especially when patients are 11 or 12 years old. Reviewing vaccination status at every healthcare encounter and taking advantage of every visit, including acute care visits, can increase HPV vaccine coverage in the United States.

HPV vaccine is an anti-cancer vaccine. Preteen and teens are relying on the adults in their lives to help protect them.

National and state vaccination coverage data for adolescent immunization will be released late August 2013 in the MMWR and will include HPV vaccine coverage for both girls and boys.

CDC DISCUSSES TRAUMATIC BRAIN INJURY

Credit:  Wikimedia Commons.

FROM: CENTERS FOR DISEASE CONTROL
TBI: What You Should Know

Traumatic brain injury (TBI) is a serious public health issue for Americans. Each year, TBI contributes to a substantial number of deaths and permanent disability. A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. The severity of a TBI may range from "mild" to "severe".

According to research from CDC, approximately 3.5 million persons have a TBI in the United States. Of these individuals:
2.1 million received care in emergency departments,
300,000 were hospitalized,
84,000 were seen in outpatient departments,
1.1 million received care from office-based physicians, and
53,000 died.
Previously referred to as the "Silent Epidemic," individuals with this injury may not have any visible scars, and symptoms may not show up or be noticed until hours or days later. Still, a TBI can cause short or long-term problems se¬riously affecting thinking, learning, memory, and/or emotions. A TBI can affect all aspects of an individual’s life, as well as that of their loved ones. This may include relationships with family and friends, as well as their ability to work or be employed, do household tasks, or drive a car.

The most common causes of TBI are from falls and car crashes. While there is no one-size-fits all solution, there are many ways to reduce the chances of a TBI, including:
Wearing a seat belt every time you drive or ride in a motor vehicle.
Never driving while under the influence of alcohol or drugs.
Avoiding activities that can distract you while you drive, such as using a cell phone, texting, and eating.
Wearing a helmet and making sure your children wear helmets while riding a bike.
Helping prevent falls by:
Encouraging older adults to improve their balance and coordination by exercising.
Using safety gates at the top and bottom of stairs to prevent young children from falling.
This March, in recognition of Brain Injury Awareness Month, CDC encourages you to learn more about TBI prevention.

CDC WANTS IMMEDIATE ACTION TO CURB DEADLY INFECTIONS IN HOSPITALS

FROM: CENTERS FOR DISEASE CONTROL
CDC: Action needed now to halt spread of deadly bacteria
Data show more inpatients suffering infections from bacteria resistant to all or nearly all antibiotics 


 A family of bacteria has become increasingly resistant to last-resort antibiotics during the past decade, and more hospitalized patients are getting lethal infections that, in some cases, are impossible to cure. The findings, published today in the Centers for Disease Control and Prevention’s
Vital Signs report, are a call to action for the entire health care community to work urgently – individually, regionally and nationally – to protect patients. During just the first half of 2012, almost 200 hospitals and long-term acute care facilities treated at least one patient infected with these bacteria.

The bacteria, Carbapenem-Resistant Enterobacteriaceae (CRE), kill up to half of patients who get bloodstream infections from them. In addition to spreading among patients, often on the hands of health care personnel, CRE bacteria can transfer their resistance to other bacteria within their family. This type of spread can create additional life-threatening infections for patients in hospitals and potentially for otherwise healthy people. Currently, almost all CRE infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, or nursing homes.

"CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections," said CDC Director Tom Frieden, M.D., M.P.H. "Doctors, hospital leaders, and public health, must work together now to implement CDC’s "detect and protect" strategy and stop these infections from spreading."

Enterobacteriaceae are a family of more than 70 bacteria including Klebsiella pneumoniae and E. coli that normally live in the digestive system. Over time, some of these bacteria have become resistant to a group of antibiotics known as carbapenems, often referred to as last-resort antibiotics. During the last decade, CDC has tracked one type of CRE from a single health care facility to health care facilities in at least 42 states. In some medical facilities, these bacteria already pose a routine challenge to health care professionals.

The Vital Signs report describes that although CRE bacteria are not yet common nationally, the percentage of Enterobacteriaceae that are CRE increased by fourfold in the past decade. One type of CRE, a resistant form of Klebsiella pneumoniae, has shown a sevenfold increase in the last decade. In the U.S., northeastern states report the most cases of CRE.

According to the report, during the first half of 2012, four percent of hospitals treated a patient with a CRE infection. About 18 percent of long-term acute care facilities treated a patient with a CRE infection during that time.

In 2012, CDC released a concise, practical CRE prevention toolkit with in-depth recommendations for hospitals, long-term acute care facilities, nursing homes and health departments. Key recommendations include:
enforcing use of infection control precautions (standard and contact precautions)
grouping patients with CRE together
dedicating staff, rooms and equipment to the care of patients with CRE, whenever possible
having facilities alert each other when patients with CRE transfer back and forth
asking patients whether they have recently received care somewhere else (including another country)
using antibiotics wisely
In addition, CDC recommends screening patients in certain scenarios to determine if they are carrying CRE. Because of the way CRE can be carried by patients from one health care setting to another, facilities are encouraged to work together regionally to implement CRE prevention programs.

These core prevention measures are critical and can significantly reduce the problem today and for the future. In addition, continued investment into research and technology, such as a testing approach called Advanced Molecular Detection (AMD), is critical to further prevent and more quickly identify CRE.

In some parts of the world, CRE appear to be more common, and evidence shows they can be controlled. Israel recently employed a coordinated effort in its 27 hospitals and dropped CRE rates by more than 70 percent. Several facilities and states in the U.S. have also seen similar reductions.

"We have seen in outbreak after outbreak that when facilities and regions follow CDC’s prevention guidelines, CRE can be controlled and even stopped," said Michael Bell, M.D., acting director of CDC’s Division of Healthcare Quality Promotion. "As trusted health care providers, it is our responsibility to prevent further spread of these deadly bacteria."

CDC SAYS HEALTH IMPACT OF ELECTRONIC CIGARETTES SHOULD BE STUDIED

FROM: CENTERS FOR DISEASE CONTROL
About one in five U.S. adult cigarette smokers have tried an electronic cigarette

In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, also known as e-cigarettes, up from about 10 percent in 2010, according to a study released today by the Centers for Disease Control and Prevention. Overall, about six percent of all adults have tried e-cigarettes, with estimates nearly doubling from 2010. This study is the first to report changes in awareness and use of e-cigarettes between 2010 and 2011.

During 2010–2011, adults who have used e-cigarettes increased among both sexes, non-Hispanic Whites, those aged 45–54 years, those living in the South, and current and former smokers and current and former smokers. In both 2010 and 2011, e-cigarette use was significantly higher among current smokers compared to both former and never smokers. Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011.

"E-cigarette use is growing rapidly," said CDC Director Tom Frieden, MD, Mph. "There is still a lot we don’t know about these products, including whether they will decrease or increase use of traditional cigarettes."

Although e-cigarettes appear to have far fewer of the toxins found in smoke compared to traditional cigarettes, the impact of e-cigarettes on long-term health must be studied. Research is needed to assess how e-cigarette marketing could impact initiation and use of traditional cigarettes, particularly among young people.

"If large numbers of adult smokers become users of both traditional cigarettes and e-cigarettes — rather than using e-cigarettes to quit cigarettes completely — the net public health effect could be quite negative," said Tim McAfee, MD MPH, director of the Office on Smoking and Health at CDC.

HHS WARNS PUBLIC OF PETS THAT CAN MAKE KIDS SICK

Photo Credit:  Wikimedia/U.S. Fish And Wildlife Service.

FROM: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
From the U.S. Department of Health and Human Services, I’m Ira Dreyfuss with HHS HealthBeat
The right animal can be fun and educational in a childcare center. But the wrong animal can make kids sick. At the Centers for Disease Control and Prevention, epidemiologist Dr. Neil Vora has some examples of risky pets. He says reptiles such as turtles, lizards and snakes – and amphibians such as frogs and salamanders – commonly carry germs called Salmonella.

"Children younger than 5 years of age are at particularly high risk for serious illness with Salmonella. This is why it’s particularly important that pets or animals carrying Salmonella are not kept in day care centers."

Vora says small pet turtles are still sold in some places despite federal rules banning sales.

His study is the CDC journal Emerging Infectious Diseases.

CDC: WHAT TO KNOW ABOUT HEART ATTACTS?

Photo:  Heart Half.  Credit:  CDC

FROM: CENTERS FOR DISEASE CONTROL
What to Know About Heart Attacks?!

A heart attack, also called a myocardial infarction, occurs when a section of the heart muscle dies or gets damaged because of reduced blood supply. Coronary Artery Disease (CAD) occurs when a substance called plaque builds up in the arteries that supply blood to the heart (called coronary arteries). CAD is the main cause of heart attack. The five major symptoms of a heart attack are—
Pain or discomfort in the jaw, neck, or back.
Feeling weak, light-headed, or faint.
Chest pain or discomfort.
Pain or discomfort in arms or shoulder.
Shortness of breath.
If you believe you or someone are experiencing the symptoms of a heart attack it is important to to call 9-1-1 immediately. Otherwise, further damage to the heart muscle can occur and an irregular heart rhythm may develop.

Bystanders who have been trained to perform cardiopulmonary resuscitation (CPR) or use a defibrillator may be able to help the victim until emergency medical personnel arrive. At the hospital, doctors will then perform tests to determine whether a heart attack is occurring and decide on the best treatment.

Remember, it’s important to recognize these symptoms and call for help because the chances of surviving a heart attack are greater when emergency treatment begins quickly.

AFRICAN AMERICAN WOMEN HAVE HIGHER BREAST CANCER DEATH RATES

FROM: U.S. CENTERS FOR DISEASE CONTROL

Disparities in breast cancer continue among U.S. women

Report shows importance of improved access to preventive care and high-quality treatment

Black women have higher death rates from breast cancer than any other racial or ethnic group. They are 40 percent more likely to die from breast cancer than white women, according to a Vital Signs report from the Centers for Disease Control and Prevention. Despite the decline in breast cancer death rates in the past 20 years, black women had higher death rates even though they had fewer new cases of breast cancer, the report says.


The report’s findings highlight the importance of educating women about the preventive benefits and coverage provided by the Affordable Care Act, including coverage of mammograms without co-pays in many health plans and, beginning in 2014, the law will expand access to health insurance coverage for 30 million previously uninsured Americans.

"Although we are making progress reducing deaths from breast cancer, we have much work to do to reduce preventable deaths, particularly among African-American women," said CDC Director Thomas R. Frieden, M.D., M.P.H. "Only when every woman receives adequate screening, timely follow-up, and high-quality treatment, will the full benefit of breast cancer screening be achieved."

The researchers reviewed data on new cases of invasive breast cancer reported during 2005 through 2009 from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. Breast cancer deaths were based on death certificates submitted to National Vital Statistics System.

Major findings:
About 40,000 women die of breast cancer each year in the United States.
Black women have 9 more deaths per 100 breast cancers diagnosed compared to white women.
Black women have higher numbers of advanced stage breast cancer (45 percent) compared with white women (35 percent).
The report says better treatment and finding breast cancer early are likely responsible for half of the recent drop in breast cancer deaths. However, black women do not get the same quality treatment for breast cancer as white women, it says.


Breast cancer is the most common cancer, and is the second leading cause of cancer death among U.S. women. A mammogram—an X-ray of the breasts—often can find breast cancer early, before it is big enough to feel as a lump, or cause other symptoms, and when it is easier to treat. Because of the Affordable Care Act, many private health plans and Medicare now cover mammograms and certain other preventive services with no copays or other out-of-pocket costs. Approximately, 5.1 million black women are estimated to receive guaranteed women's preventive health services without cost-sharing under the Affordable Care Act.

CDC’s National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured, and underinsured women access to timely breast and cervical cancer screening and diagnostic services in all 50 states, the District of Columbia, five U.S. territories, and 11 American Indian/Alaska Native tribes or tribal organizations.
For information about CDC’s efforts in breast cancer prevention, please visit http://www.cdc.gov/cancer/breast.

U.S. HIGH SCHOOL STUDENT DRINKING AND DRIVING HAS DECREASED SINCE 1991

Credit:  Wikimedia.

FROM: CENTERS FOR DISEASE CONTROL
The percentage of teens in high school who drink and drive has decreased by more than half since 1991,* but more can be done. Nearly one million high school teens drank alcohol and got behind the wheel in 2011. Teen drivers are 3 times more likely than more experienced drivers to be in a fatal crash. Drinking any alcohol greatly increases this risk for teens.

Research has shown that factors that help to keep teens safe include parental involvement, minimum legal drinking age and zero tolerance laws, and graduated driver licensing systems. These proven steps can protect the lives of more young drivers and everyone who shares the road with them.

*High school students aged 16 years and older who, when surveyed, said they had driven a vehicle one or more times during the past 30 days when they had been drinking alcohol.

Drinking and driving can be deadly, especially for teens
Fewer teens are drinking and driving, but this risky behavior is still a major threat.
Drinking and driving among teens in high school has gone down by 54% since 1991. Still, high school teens drive after drinking about 2.4 million times a month.
85% of teens in high school who report drinking and driving in the past month also say they binge drank. In the survey, binge drinking was defined as having 5 or more alcoholic drinks within a couple of hours.
1 in 5 teen drivers involved in fatal crashes had some alcohol in their system in 2010. Most of these drivers (81%) had BACs* higher than the legal limit for adults.
*Blood alcohol concentration. It is illegal for adults to drive with a BAC of .08% or higher. It is illegal for anyone under age 21 to drive after drinking any alcohol in all US states.

WEST NILE VIRUS STRIKES EARLY THIS YEAR

050910-N-2653P-132 Naval Air Station (NAS) Joint Reserve Base (JRB) New Orleans, La. (Sept. 10, 2005) - Preventative Medicine Technician (PMT), Hospital Corpsman 1st Class Jonathan Wells, assigned to Forward Deployable Preventive Medicine Unit (FDPMU) East, removes a Light Trap provided by the Centers for Disease Control (CDC) from a tent city area on board NAS JRB New Orleans. The FDPMU is assisting the CDC and the Louisiana Department of Public Health to eliminate vector-borne disease and other insect-related problems associated with Louisiana’s mosquito population. Diseases like West Nile Virus can be transmitted by mosquitoes, which thrive in wet ecological terrain like that inherent to Louisiana. U.S. Navy photo by Journalist 1st Class James Pinsky (RLEASED)

FROM: CENTERS FOR DISEASE CONTROL
The Centers for Disease Control and Prevention is urging people to take steps to prevent West Nile virus infections. Outbreaks of West Nile virus disease occur each summer in the United States. This year, some areas of the country are experiencing earlier and greater activity.

Thus far in 2012, 42 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 241 cases of West Nile virus disease, including four deaths, have been reported to CDC. This is the highest number of cases reported through the end of July since 2004. Almost 80 percent of the cases have been reported from three states, Texas, Mississippi, and Oklahoma.

West Nile virus is transmitted to people by infected mosquitoes. In the United States, most people are infected from June through September, and the number of these infections usually peaks in mid-August. Seasonal outbreaks often occur in local areas that can vary from year to year. Many factors impact when and where outbreaks occur, such as weather, numbers of mosquitoes that spread the virus, and human behavior.

"It is not clear why we are seeing more activity than in recent years," said Marc Fischer, M.D., M.P.H., medical epidemiologist with CDC’s Arboviral Diseases Branch. "Regardless of the reasons for the increase, people should be aware of the West Nile virus activity in their area and take action to protect themselves and their family."

The best way to prevent West Nile virus disease is to avoid mosquito bites:
Use insect repellents when you go outdoors.
Wear long sleeves and pants during dawn and dusk.
Install or repair screens on windows and doors. Use air conditioning, if you have it.
Empty standing water from items outside your home such as flowerpots, buckets, and kiddie pools.
Approximately 1 in 5 people who are infected with West Nile virus will develop symptoms such as fever, headache, body aches, joint pains, vomiting, diarrhea, or rash. Less than 1 percent will develop a serious neurologic illness such as encephalitis or meningitis (inflammation of the brain or surrounding tissues). About 10 percent of people who develop neurologic infection due to West Nile virus will die. People over 50 years of age and those with certain medical conditions, such as cancer, diabetes, hypertension, kidney disease, and organ transplants, are at greater risk for serious illness.

There are no medications to treat, or vaccines to prevent, West Nile virus infection. People with milder illnesses typically recover on their own, although symptoms may last for several weeks. In more severe cases, patients often need to be hospitalized to receive supportive treatment, such as intravenous fluids, pain medication, and nursing care. Anyone who has symptoms that cause concern should contact a health care provider.

CDC SAYS SUNBURNS, TANNING BEDS ARE COMMON HIGH-RISK BEHAVIORS CAUSING SKIN CANCER

Photo:  Credit NASA  
FROM:  U.S. CENTERS FOR DISEASE CONTROL
High-risk behaviors for skin cancer common among young adults
Half of adults younger than age 30 report being sunburned; indoor tanning rates highest among white womenYoung adults are increasing their risk for developing skin cancer, according to two studies by the Centers for Disease Control and Prevention and the National Cancer Institute.

One study, of people aged 18-29, found that 50 percent reported at least one sunburn in the past year, despite an increase in protective behaviors such as sunscreen use, seeking shade, and wearing long clothing to the ankles. Another report found that indoor tanning is common among young adults, with the highest rates of indoor tanning among white women aged 18-21 years (32 percent) and 22-25 years (30 percent). Both reports evaluated data from the National Health Interview Survey’s Cancer Control Supplement. They are published in today’s issue of CDC’s Morbidity and Mortality Weekly Report.

“More public health efforts, including providing shade and sunscreen in recreational settings, are needed to raise awareness of the importance of sun protection and sunburn prevention to reduce the burden of skin cancer,” said Marcus Plescia, M.D., M.P.H., director of CDC’s Division of Cancer Prevention and Control. “We must accelerate our efforts to educate young adults about the dangers of indoor tanning to prevent melanoma as this generation ages.”

Skin cancer is the most common form of cancer in the United States, and melanoma is the most deadly type of skin cancer.  Exposure to ultraviolet radiation from the sun and from indoor tanning equipment is the most important preventable risk factor for skin cancer. Indoor tanning before age 35 increases a person’s risk of getting melanoma by 75 percent. Sunburn indicates too much exposure to ultraviolet radiation.

“Efforts to shape public policies awareness regarding indoor tanning generally have been targeted toward adolescents rather than young adults to help change behavior of minors,” said Anne Hartman, study coauthor from the Applied Research Program of NCI’s Division of Cancer Control and Population Sciences.  “This study suggests that as adolescents mature into young adults, they may continue to need environmental support to develop and maintain healthy behaviors and to change their perspectives about tanning.”
Findings from the two studies:
Among adults aged 18-29 years, whites reported the highest sunburn prevalence (66 percent in 2010) whereas the lowest rates were among blacks (11 percent in 2010). Although sunburn is not as common among blacks as compared to whites, blacks can get sunburned.
The most common sun protective behaviors reported among women aged 18-29 years in 2010 were using sunscreen (37 percent) and staying in the shade (35 percent).  White women were less likely to stay in the shade, and black women were less likely to use sunscreen compared to other racial/ethnic groups. Among men aged 18-29 years, the most common sun protective behaviors reported in 2010 were wearing long clothing to the ankles (33 percent) and staying in the shade (26 percent).

Among white women aged 18-21 years who reported indoor tanning, an average of 28 visits occurred in the past year. White women aged 18-21 years were the most common users of indoor tanning.

The highest prevalence of indoor tanning was reported among white women aged 18-21 years residing in the Midwest (44 percent), and those aged 22-25 years in the South (36 percent).

Among white adults who reported indoor tanning, 58 percent of women and 40 percent of men used one 10 or more times in the previous year.

People should take these steps to protect themselves from ultraviolet light exposure that could lead to skin cancer by:
Seeking shade, especially during midday hours (10 a.m. to 2 p.m.).
Wearing clothing to protect exposed skin.
Wearing a wide-brimmed hat to shade the face, head, ears, and neck.
Wearing wrap-around sunglasses that block as close to 100 percent of ultraviolet A (UVA) and ultraviolet B (UVB) rays as possible.  Sunglasses safeguard your eyes from UVA and UVB rays, protect the tender skin around your eyes from sun exposure, and reduce the risk of cataracts and ocular melanoma.
Using sunscreen with sun protective factor 15 or higher, and both UVA and UVB protection.
Avoiding indoor tanning.

MALARIA IS STILL A THREAT TO MILLIONS

FROM:  U.S. CENTERS FOR DISEASE CONTROL
"Have You Heard?"
Malaria threatens security of millions
Malaria, a disease spread by mosquito bites, can lead to impoverishment, disability, and death. Beyond the loss of human potential, malaria’s direct costs total more than $12 billion each year and cause substantial economic losses for entire nations. Encouragingly, inexpensive yet simple interventions can dramatically reduce malaria’s impact.

From global efforts to grass-roots mobilization, resources committed to fight malaria have increased greatly in the past decade. Hundreds of millions of life-saving insecticide-treated bed nets and effective antimalarial medicines are now available to people who need them, especially pregnant women and children under 5 years old, who are most vulnerable to malaria.

The impact of this massive scale-up has been a dramatic decline in malaria cases and deaths---in many countries by as much as 50 percent. Globally, WHO estimates that malaria deaths decreased by a third between 2000 and 2010, with most of this reduction in Africa. These achievements are fragile, however, because resources are constrained in the current economy, bed nets wear out, and parasites develop resistance to medicines.

World Malaria Day, April 25th, and its theme “Sustain Gains, Save Lives: Invest in Malaria,” remind us that successes of the past decade can be easily reversed.

The U.S. government has a major role in the global malaria partnership. CDC, which began in 1946 as the agency to control malaria in the United States, is a leader in global malaria efforts. The successful President’s Malaria Initiative is jointly implemented by the U.S. Agency for International Development and CDC and has greatly contributed to recent decreases in malaria.

CDC has played a key role in developing and improving the tools to prevent and treat malaria: treated bed nets and house-spraying to protect families from mosquitoes, accurate diagnostic tests and high-quality effective drugs, and treatment for pregnant women that protects them and their babies.

What more can we do?

Even as many individuals and companies contribute to organizations that buy and distribute bed nets, our nation is harnessing its technical expertise to develop and evaluate new prevention and control methods. CDC is working to ensure that new medicines, vaccines, diagnostic tests, and mosquito control products are deployed effectively, and is also investigating new ways to collect the strategic information needed to track our progress and ensure we invest wisely.

With increased knowledge, the right tools, and renewed commitment to decrease malaria, we can sustain gains made in past decade and save lives.
Thomas R. Frieden, M.D., M.P.H
Director, Centers for Disease Control and Prevention

U.S. CDC SAYS UNINTENTIONAL CHILD INJURIES DOWN 30% IN 10 YEARS

FROM: U.S. CENTERS FOR DISEASE CONTROL

Death rates from unintentional injury among children dropped by nearly 30 percent in 10 years

Injuries remain number one killer of youth

Death rates from unintentional injuries among children and adolescents from birth to age 19 declined by nearly 30 percent from 2000 to 2009, according to a new Vital Signs report from the Centers for Disease Control and Prevention. 

However, more than 9,000 children lost their lives as a result of unintentional injury in the United States in 2009. And although rates for most causes of child injuries have been dropping, suffocation rates are on the rise, with a 54 percent increase in reported suffocation among infants less than 1 year old, the report says.  Poisoning death rates also increased, with a 91 percent increase among teens aged 15-19, largely due to prescription drug overdose, it said.

This Vital Signs report is CDC’s first study to show fatal unintentional injury trends by cause and by state for children from birth to 19 years. The most common cause of death from unintentional injury for children is motor vehicle crashes; other leading causes include suffocation, drowning, poisoning, fires, and falls.

“Kids are safer from injuries today than ever before. In fact, the decrease in injury death rates in the past decade has resulted in more than 11,000 children’s lives being saved,” said CDC Director Thomas Frieden, M.D., M.P.H. “But we can do more. It’s tragic and unacceptable when we lose even one child to an avoidable injury.”

Child injury death rates varied substantially by state in 2009, ranging from less than 5 deaths per 100,000 children in Massachusetts and New Jersey to more than 23 deaths per 100,000 children in South Dakota and Mississippi.

Death rates from motor vehicle crashes dropped by 41 percent from 2000-2009. Several factors have played a role in this reduction, including improvements in child safety and booster seat use and use of graduated drivers licensing systems for teen drivers. However, crashes remain the leading cause of unintentional injury death for children.

Poisoning deaths have been steadily increasing among 15- to 19 year-olds, largely due to prescription drug overdoses. According to other CDC research, appropriate prescribing, proper storage and disposal, discouraging medication sharing, and state-based prescription drug monitoring programs could reduce these deaths. The increase in suffocation deaths among infants could be curbed by following the American Academy of Pediatrics’ recommendations for safe infant sleeping environments. These recommendations state that infants should sleep in safe cribs, alone, on their backs, with no loose bedding or soft toys.

“Every 4 seconds, a child is treated for an injury in the emergency department, and every hour, a child dies as a result of an injury,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control. “Child injury remains a serious problem in which everyone –including parents, state health officials, health care providers, government and community groups – has a critical role to play to protect and save the lives of our young people.”

CDC and more than 60 partner organizations are releasing a National Action Plan on Child Injury Prevention in conjunction with the Vital Signs report. The National Action Plan’s overall goals are to:

• Raise awareness about the problem of child injury and the effects on our nation.
• Highlight prevention solutions by uniting stakeholders around a common set of goals and strategies.
• Mobilize action on a national, coordinated effort to reduce child injury.

For a copy of the plan and more information about child injury prevention, visitwww.cdc.gov/safechild.

CDC Vital Signs is a report that appears each month as part of the CDC journal Morbidity and Mortality Weekly Report (MMWR). The report provides the latest data and information on key health indicators such as cancer prevention, obesity, tobacco use, alcohol use, prescription drug overdose, HIV/AIDS, motor vehicle safety, health care-associated infections, cardiovascular health, teen pregnancy, child injuries, and food safety.

CDC SAYS U.S. POPULATION HAS GOOD STUFF IN THEM

FROM:  CENTERS FOR DISEASE CONTROL
CDC report finds U.S. population has good levels of some essential vitamins and nutrients
Higher deficiency rates in some groups deserve attentionOverall, the U.S. population has good levels of vitamins A and D and folate in the body, but some groups still need to increase their levels of vitamin D and iron, according to the Second National Report on Biochemical Indicators of Diet and Nutrition, released today by the Centers for Disease Control and Prevention.

The report offers a limited but generally favorable review of the nation’s nutrition status although the findings do not necessarily indicate that people consume healthy and balanced diets.

CDC’s Division of Laboratory Sciences in the National Center for Environmental Health measured these indicators in blood and urine samples collected from participants in CDC’s National Health and Nutrition Examination Survey. Data are presented for the years 1999-2006, with emphasis on newly available data for 2003-2006.

 “These findings are a snapshot of our nation’s overall nutrition status,” said Christopher Portier, Ph.D., director of CDC’s National Center for Environmental Health.  “Measurements of blood and urine levels of these nutrients are critical because they show us whether the sum of nutrient intakes from foods and vitamin supplements is too low, too high, or sufficient.”

The report also found that deficiency rates for vitamins and nutrients vary by age, gender, or race/ethnicity and can be as high as 31 percent for vitamin D deficiency in non-Hispanic blacks.

“Research shows that good nutrition can help lower people’s risk for many chronic diseases. For most nutrients, the low deficiency rates, less than 1 to 10 percent, are encouraging, but higher deficiency rates in certain age and race/ethnic groups are a concern and need additional attention,” said Christine Pfeiffer, Ph.D.,  lead researcher, in the Division of Laboratory Sciences in CDC’s National Center for Environmental Health.
CDC’s Second Nutrition Report establishes blood and urine reference levels for 58 biochemical indicators; more than twice as many indicators as its first report, published in 2008.  The report includes first-time data for a new indicator of iron deficiency and for 24 healthy and unhealthy fatty acids.

Folic acid fortification:  A sustained public health success
The report found that the fortification of cereal-grain products with folic acid, which began in 1998, has had a sustained positive impact on blood folate levels.  The report shows folate deficiency dropped to less than 1 percent after fortification.  The report also shows that blood folate levels in all race/ethnic groups are 50 percent higher since fortification began.

Before fortification began, approximately 12 percent of women of childbearing age were deficient in folate, as determined by blood folate levels.  Folate is essential during periods when cells rapidly divide and grow, which is particularly important for women prior to and during pregnancy and for children during infancy.  Folic acid can help prevent some major birth defects of the baby’s brain and spine, such as spina bifida.

Vitamin D deficiency much higher in black Americans
The report found the highest rates of vitamin D deficiency in non-Hispanic blacks (31 percent) despite clinical data showing greater bone density and fewer fractures in this group. Further research is needed to explain why non-Hispanic blacks have better bone health but yet have a higher rate of vitamin D deficiency. According to the report, the vitamin D deficiency rate for Mexican-Americans was 12 percent and for non-Hispanic whites it was 3 percent.
Vitamin D is essential for good bone health but it may also improve muscle strength and protect against cancer and type 2 diabetes. Researchers are investigating these potential benefits, as well as, the vitamin D requirements for various groups.

Iodine levels border on insufficiency in women of childbearing age
Findings were not as encouraging with regard to the iodine status in young women (20-39 years of age). This age group had iodine levels that were just above iodine insufficiency. The young women also had the lowest iodine levels among any age group of women. Iodine is an essential component of thyroid hormones that regulate human growth and development.  Iodine deficiency disorders include mental retardation, hypothyroidism, goiter, cretinism, and varying degrees of other growth and developmental abnormalities.  Iodine is especially important in women during childbearing years to ensure the best possible brain development of the fetus during pregnancy.
First measurements of new iron deficiency marker and of both healthy and unhealthy fatty acids

Using a new marker of iron status, the report indicates higher rates of iron deficiency in Mexican-American children aged 1 to 5 years (11 percent) and in non-Hispanic black (16 percent) and Mexican-American women (13 percent) of childbearing age (12 to 49 years) when compared to other race/ethnic groups. The new iron marker measurements will help clinicians better interpret iron status in individuals, especially in persons with chronic disease that includes inflammation, such as certain cancers.
The report provides first-time data on blood levels of fatty acids in the U.S. population. These include heart healthy polyunsaturated fatty acids as well as saturated fatty acids that increase risk of heart disease.  The report found heart healthy polyunsaturated fatty acid levels in plasma differ by race/ethnicity.  These first time measurements provide a baseline that will allow CDC to track fatty acid levels over time, which will evaluate our nation’s progress toward heart healthy diets.

Most comprehensive biochemical assessment of the nation’s nutrition status
CDC’s report is a detailed biochemical assessment of the nutrition status of the U.S. population. It is the second in a series of publications that provide an ongoing assessment of the U.S. population’s nutrition status. The series of reports provide information specific to population groups defined by age, gender, and race/ethnicity to show how these factors affect nutrition status in the United States.
CDC plans further analysis of report data that will help identify the influence of socio-economic and lifestyle factors on levels of nutrients in blood and urine. The agency also plans to continue its assessment of the nation’s nutrition status in future reports.

CDC SAYS U.S. CANCER DEATH RATES ARE DECLINING

The graphs and following excerpt are from the Centers for Disease Control website:
Report to the nation finds continuing declines in cancer death rates since the early 1990s
Special feature highlights cancers associated with excess weight and lack of sufficient physical activity

Death rates from all cancers combined for men, women, and children continued to decline in the United States between 2004 and 2008, according to the Annual Report to the Nation on the Status of Cancer, 1975–2008. The overall rate of new cancer diagnoses, also known as incidence, among men decreased by an average of 0.6 percent per year between 2004 and 2008.  Overall cancer incidence rates among women declined 0.5 percent per year from 1998 through 2006 with rates leveling off from 2006 through 2008.

The report is co–authored by researchers from the Centers for Disease Control and Prevention, the North American Association of Central Cancer Registries, the National Cancer Institute, and the American Cancer Society. It appears early online in the journal CANCER, and will appear in print in the May issue.

The special feature section highlights the effects of excess weight and lack of physical activity on cancer risk. Esophageal adenocarcinoma, cancers of the colon and rectum, kidney cancer, pancreatic cancer, endometrial cancer, and breast cancer among postmenopausal women are associated with being overweight or obese. Several of these cancers also are associated with not being sufficiently physically active.

“This report demonstrates the value of cancer registry data in identifying the links among physical inactivity, obesity, and cancer,” said CDC Director Thomas R. Frieden, M.D. “It also provides an update of how we are progressing in the fight against cancer by identifying populations with unhealthy behaviors and high cancer rates that can benefit from targeted, lifesaving strategies, and interventions to improve lifestyle behaviors and support healthy environments.”

For more than 30 years, excess weight, insufficient physical activity, and an unhealthy diet have been second only to tobacco as preventable causes of disease and death in the United States.  However, since the 1960s, tobacco use has declined by a third while obesity rates have doubled, significantly impacting the relative contributions of these factors to the disease burden.  Excess weight and lack of sufficient physical activity have been linked to increased risk of cardiovascular disease, hypertension, diabetes, and arthritis, as well as many cancers.

“In the United States, 2 in 3 adults are overweight or obese and fewer than half get enough physical activity,” said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. “Between children and youth, 1 in 3 is overweight or obese, and fewer than 1 in 4 high school students get recommended levels of physical activity. Obesity and physical inactivity are critical problems facing all states. For people who do not smoke, excess weight and lack of sufficient physical activity may be among the most important risk factors for cancer.”

The Report to the Nation was first issued in 1998. In addition to drops in overall cancer mortality and incidence, this year's report also documents the second consecutive year of decreasing lung cancer mortality rates among women. Lung cancer death rates in men have been decreasing since the early 1990s.

Colorectal cancer incidence rates also decreased among men and women from 1999 through 2008.  Breast cancer incidence rates among women declined from 1999 through 2004 and plateaued from 2004 through 2008.  Incidence rates of some cancers, including pancreas, kidney, thyroid, liver, and melanoma, increased from 1999 through 2008.

“The continued declines in death rates for all cancers, as well as the overall drop in incidence, is powerful evidence that the  nation's investment in cancer research produces life–saving approaches to cancer prevention, screening, diagnosis, and treatment,” said NCI Director Harold E. Varmus, M.D.  “But, it is also important to note that investments we make today are critical if we hope to see these declines in incidence and death from cancer reflected in future Reports to the Nation.”

Among children aged 19 years or younger, cancer incidence rates increased 0.6 percent per year from 2004 through 2008, continuing trends from 1992, while death rates decreased 1.3 percent per year during the same period. These patterns mirror longer–term trends.

Among racial and ethnic groups, the highest cancer incidence rates between 2004 and 2008 were among black men and white women. Cancer death rates from 2004 through 2008 were highest among black men and black women, but these groups showed the largest declines for the period between 1999 and 2008, compared with other racial groups. The differences in death rates by racial/ethnic group, sex, and cancer site may reflect differences in risk factors, as well as access to and use of screening and treatment.

“While the sustained decline in cancer mortality rates is good news, the persistence of disparities among racial and ethnic groups continues to concern us,” said Betsy A. Kohler, executive director of NAACCR. “The collection of comprehensive cancer surveillance data on all patients may provide clues to understanding these differences and addressing them.”

The report notes that continued progress against cancer in the United States will require individual and community efforts to promote healthy weight and sufficient physical activity among youth and adults.
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POISONING CAUSES MANY U.S. DEATHS ACCORDING TO THE CDC

The following excerpt is from the CDC website:
Poisoning is a Major Cause of Death from Injury in the U.S.
US Government raising awareness of accidental exposures during National Poison Prevention Week
WASHINGTON – The Environmental Protection Agency is joining forces with its federal partners to raise awareness of the dangers of poisoning, especially to children, during National Poison Prevention Week, March 18-24. In just the past year, America’s 57 poison control centers fielded 4 million calls, treating 2.4 million human poison exposures and handling 1.6 million information calls.

EPA, the Centers for Disease Control and Prevention, Health Resources and Services Administration, Consumer Products Safety Commission, Department of Housing and Urban Development, as well as the American Association of Poison Control Centers are urging parents and caregivers to be vigilant and take steps now to prevent unnecessary exposures and poisonings throughout the year.

In recognition of National Poison Prevention Week, EPA urges parents and caregivers to secure chemicals and pesticides in locked cabinets out of children's reach. According to recently published poison-center data, annually more than 150,000 calls to poison centers involved pesticides and disinfectants. Greater than half of pesticide exposures involved children five years or younger. Additionally, the top five most-common exposures to children include cosmetics and personal care products, pain medication, cleaning products, foreign objects, and creams.

The development of child-resistant packaging on medicines and household chemicals and the banning of lead-based paint have had a significant impact in preventing poisonings and making homes safer. In addition, new EPA packaging requirements ensure that children and pets cannot access certain pesticides. For example, manufacturers of rodenticides now must enclose the products in plastic bait stations so that only the target pests are affected.

Even though progress has been made there is need for increased awareness about existing hazards posed from pest control products, prescription medicine abuse and household chemicals.

At the front line of the effort to reduce poisonings are the activities of the National Poison Prevention Week Council, which is marking its 50th anniversary this year. The council's key goal is to create national awareness about the risk of injury or death due to poisoning.

The themes for the Seven Days of Poisoning Prevention are:

Sunday:     Poisonings Span a Lifetime
Monday:     Children Act Fast, So Do Poisons
Tuesday:     Poison Centers: Saving Lives 24/7  
Wednesday:     Take Your Medicines Safely
Thursday:     Home, Safe, Home
Friday:         Poison Prevention Superhero: Share Your Stories
Saturday:     50 Ways to Prevent Poisonings

CDC SAYS IMPORTED FOODS INCREASING ILLNESSES IN U.S.

THE FOLLOWING EXCERPT IS FROM THE CDC WEBSITE:

CDC research shows outbreaks linked to imported foods increasing

Fish and spices the most common sources

Foodborne disease outbreaks caused by imported food appeared to rise in 2009 and 2010, and nearly half of the outbreaks implicated foods imported from areas which previously had not been associated with outbreaks, according to research from the Centers for Disease Control and Prevention, presented today at the International Conference on Emerging Infectious Diseases in Atlanta.

“It's too early to say if the recent numbers represent a trend, but CDC officials are analyzing information from 2011 and will continue to monitor for these outbreaks in the future,” said Hannah Gould, Ph.D., an epidemiologist in CDC’s Division of Foodborne, Waterborne and Environmental Diseases and the lead author.

CDC experts reviewed outbreaks reported to CDC’s Foodborne Disease Outbreak Surveillance System from 2005-2010 for implicated foods that were imported into the United States. During that five-year period, 39 outbreaks and 2,348 illnesses were linked to imported food from 15 countries. Of those outbreaks, nearly half (17) occurred in 2009 and 2010. Overall, fish (17 outbreaks) were the most common source of implicated imported foodborne disease outbreaks, followed by spices (six outbreaks including five from fresh or dried peppers). Nearly 45 percent of the imported foods causing outbreaks came from Asia.

“As our food supply becomes more global, people are eating foods from all over the world, potentially exposing them to germs from all corners of the world, too,” Gould said. “We saw an increased number of outbreaks due to imported foods during recent years, and more types of foods from more countries causing outbreaks.”

According to a report by the Department of Agriculture's Economic Research Service (ERS), U.S. food imports grew from $41 billion in 1998 to $78 billion in 2007.  Much of that growth has occurred in fruit and vegetables, seafood and processed food products.  The report estimated that as much as 85 percent of the seafood eaten in the United States is imported, and depending on the time of the year, up to 60 percent of fresh produce is imported. ERS also estimated that about 16 percent of all food eaten in the United States is imported. The types of food causing the outbreaks in this analysis aligned closely with the types of food that were most commonly imported.

Gould warned that the findings likely underestimate the true number of outbreaks due to imported foods as the origin of many foods causing outbreaks is either not known or not reported.

“We need better - and more - information about what foods are causing outbreaks and where those foods are coming from,” Gould said. "Knowing more about what is making people sick, will help focus prevention efforts on those foods that pose a higher risk of causing illness.”

Recently, the Food and Drug Administration has have stepped up its efforts to conduct environmental assessments to determine the root cause of outbreaks. With lessons learned from outbreaks, measures will be taken to prevent such outbreaks in the future.  The newly enacted FDA Food Safety Modernization Act is also a major step in establishing a prevention based food safety system that would address domestic as well as imported foods. CDC, FDA and USDA will continue to work together to prevent foodborne illness and stop harmful products from entering commerce.

CDC WARNS OF DEADLY BACTERIA IMPACTING PATIENTS

The following excerpt is from the Centers For Disease Control website:

"Life-threatening germ poses threat across medical facilities
CDC highlights steps to prevent spread of deadly C. difficile bacteria, which impacts patients in nursing homes and outpatient care, not just hospitals

Infections from Clostridium difficile (C. difficile), a bacteria that causes diarrhea and other health issues, is a patient safety concern in all types of medical facilities, not just hospitals as traditionally thought, according to a new Vital Signs report today from the Centers for Disease Control and Prevention. Â While many health care-associated infections, such as bloodstream infections, declined in the past decade, C. difficileinfection rates and deaths climbed to historic highs.

“C. difficile harms patients just about everywhere medical care is given,” said CDC Director Thomas R. Frieden, M.D., M.P.H.  “Illness and death linked to this deadly disease do not have to happen. Patient lives can be saved when health care providers follow the 6 Steps to Prevention, which include key infection control and smart antibiotic prescribing recommendations.”

C. difficile is linked to about 14,000 U.S. deaths every year. Those most at risk are people who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90 percent of deaths occur in people 65 and older. Previously released estimates based on billing data show that the number of U.S. hospital stays related to C. difficile remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra costs to the health care system. However, the Vital Signsreport shows that these hospital estimates may only represent one part of C. difficile’s overall impact.

According to Vital Signs, 94 percent of C. difficile infections are related to medical care. About 25 percent of C. difficile infections first show symptoms in hospital patients; 75 percent first show in nursing home patients or in people recently cared for in doctor’s offices and clinics. Â

Although the proportion of infection onset is lower in hospitals, these facilities remain at the core of prevention since many patients with C. difficile infections are transferred to hospitals for care, raising risk of spread within the facility.  The Vital Signs report shows that half of C. difficile infections diagnosed at hospitals were already present at the time the patient was admitted (present on admission), usually after getting care in other facilities. The other half were related to care given in the hospital where the infection was diagnosed.

The report highlights three programs showing early success in reducing C. difficile infection rates in hospitals.  Seventy-one hospitals in Illinois, Massachusetts, and New York decreased C. difficileinfections by 20 percent in less than two years by following infection control recommendations.  These promising results follow similar efforts in England, a nation that dropped C. difficile infections by more than 50 percent during a recent three-year period.Â

“C. difficile infections are usually a regional problem since patients transfer back and forth between facilities, allowing the disease to spread,” said L. Clifford McDonald, M.D., CDC medical epidemiologist and lead author of the study. “Health departments have the ability to work with many types of health care facilities, and have a unique opportunity to coordinate local, comprehensive prevention programs to reduce the occurrence of these infections.”

Patients get C. difficile infections most often within a few months of taking antibiotics and also receiving medical care. Antibiotics are lifesaving medicines that stop infections, but they also destroy the body’s good bacteria for several 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. Infection risk generally increases with age; children are at lower risk for C. difficile infection. Identifying C. difficile infection early and stopping its spread to other people can save lives.Â
Patients can help stop C. difficile by:

- Taking antibiotics only as prescribed by your doctor. Antibiotics can be lifesaving medicines.Â
- Telling your doctor if you have been on antibiotics and get diarrhea within a few months.
- Washing your hands after using the bathroom.
- Trying to use a separate bathroom if you have diarrhea, or being sure the bathroom is cleaned well if someone with diarrhea has used it.

CDC Vital Signs is a report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators – cancer prevention, obesity, tobacco use, alcohol use, prescription drug overdose, HIV/AIDS, motor vehicle passenger safety, health care–associated infections, cardiovascular health, teen pregnancy, access to health care, and food safety.