Stroke Drops to Fourth Leading Cause of Death in 2008

/PRNewswire/ -- Stroke is now the fourth leading cause of death in the United States, down from the third place ranking it has held for decades, according to preliminary 2008 death statistics released today by CDC's National Center for Health Statistics. While deaths from stroke and several other chronic diseases are down, deaths due to chronic lower respiratory disease increased in 2008.

There were 133,750 deaths from stroke in 2008. Age-adjusted death rates from stroke declined 3.8 percent between 2007 and 2008. Meantime, there were 141,075 deaths from chronic lower respiratory disease, and the death rate increased by 7.8 percent.

Some of the increase in deaths may be due to a modification made by the World Health Organization in the way deaths from chronic lower respiratory diseases are classified and coded. The National Center for Health Statistics will conduct a thorough analysis on this change and its effect on the chronic lower respiratory disease category before the final 2008 deaths data are released.

"Deaths: Preliminary Data for 2008," also finds that life expectancy at birth dropped slightly to 77.8 years from 77.9 years in 2007. Life expectancy was down by one-tenth of a year (a little over a month) for both men and women. However, black males had a record high life expectancy in 2008 of 70.2 years – up from 70 years in 2007. The life expectancy gap between the white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007.

The data are based on 99 percent of death certificates reported to NCHS through the National Vital Statistics System from all 50 states, the District of Columbia and U.S. territories.

Other findings:

* Heart disease and cancer, the two leading causes of death, still accounted for nearly half (48 percent) of all deaths in 2008.
* In addition to stroke, mortality rates declined significantly for five of the other 15 leading causes of death: accidents/unintentional injuries (3.5 percent), homicide (3.3 percent), diabetes (3.1 percent), heart disease (2.2 percent), and cancer (1.6 percent).
* In addition to chronic lower respiratory disease, death rates increased significantly in 2008 for Alzheimer's disease (7.5 percent), influenza and pneumonia (4.9 percent), high blood pressure (4.1 percent), suicide (2.7 percent), and kidney disease (2.1 percent).
* The preliminary infant mortality rate for 2008 was 6.59 infant deaths per 1,000 live births, a 2.4 percent decline from the 2007 rate of 6.77 and an all-time record low. Birth defects were the leading cause of infant death in 2008, followed by disorders related to preterm birth and low birth weight. Sudden infant death syndrome (SIDS) was the third leading cause of infant death in the United States.
* Overall, there were 2,473,018 deaths in the United States in 2008, according to the preliminary deaths report -- 49,306 more deaths than the 2007 total.
* The age-adjusted death rate for the U.S. population fell to 758.7 deaths per 100,000 in 2008 compared to the 2007 rate of 760.2.

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CDC Unveils New Adult Vaccination Rates; nfid Surveys Illuminate Barriers to Vaccine Uptake

/PRNewswire/ -- New data from the Centers for Disease Control and Prevention (CDC) show that adults remain largely unvaccinated against preventable infectious illnesses. At a news conference convened today by the National Foundation for Infectious Diseases (NFID), experts in public health, infectious disease, oncology and other medical specialties discussed the data and the health consequences for adults who skip vaccines. They collectively called on all adults and health care providers to improve vaccination rates.

"For more than six decades, vaccines have protected us from infectious illnesses that have a wide range of consequences, from lost work days and inability to meet our daily obligations, to pain, discomfort, hospitalization, long-term disability and death," said Susan J. Rehm, M.D., NFID medical director. According to Dr. Rehm, by foregoing needed vaccines, adults not only leave themselves vulnerable to sickness, but they expose those around them to unnecessary risks, too.

This problem is evident right now, as pertussis (whooping cough) continues to claim the lives of infants in California, while adults, who are frequently responsible for transmitting the disease to infants, fail to get the one-time pertussis booster vaccine. The impact of other vaccine-preventable infections may not be as immediately apparent, but they are no less important. Other vaccines for adults protect against viruses that cause several types of cancer, reactivation of the chickenpox virus that causes shingles later in life, and infection with bacteria that are the leading cause of community-acquired pneumonia.

New survey results from NFID suggest that doctor/patient communication challenges may be at least part of the problem. While physicians perceive they are encouraging their adult patients to be vaccinated, patients say the topic of vaccination rarely comes up during their doctor visits.

Vaccination rates highest among seniors; lowest among minority groups

In unveiling the adult vaccination data from the 2009 National Health Interview Survey (NHIS), Melinda Wharton, M.D., M.P.H., deputy director of the National Center for Immunization and Respiratory Diseases at the CDC, noted that the highest immunization rates are among older Americans, who tend to be vaccinated against influenza and pneumococcal infections. She suggested that one reason for this might be that older persons tend to have more routine visits with health care providers, providing more opportunities to learn about and adopt good preventive care behaviors.

"A good ongoing relationship with your medical provider is positive for so many reasons," said Dr. Wharton, "not least of which is that you will have an ongoing opportunity learn about the best ways to stay healthy, including the best preventive care choices like vaccines."

While adult vaccination rates are showing slow improvement overall, one vaccination trend Dr. Wharton specifically noted is the 7.4 percent decrease in pneumococcal vaccination rate in high-risk adults 19 to 64 years of age. She pointed out that this is not because people are suddenly foregoing this vaccine. Rather, the decrease reflects the recent addition of new risk groups -- namely smokers and people with asthma -- increasing the pool of people who should get the vaccine. Dr. Wharton called on smokers and people with asthma to check with their physicians or other health care providers about this vaccine.

In addition to generally low adult vaccination rates, Dr. Wharton touched on the problem of racial and ethnic vaccination disparities. While strides have been made to close racial and ethnic gaps, some significant vaccination gaps continue to exist among Whites, Blacks and Hispanics.

Vaccine (age and/or risk status)	Non- Hispanic White (%)	Non- Hispanic Black (%)	Hispanic or Latino (%)
Tetanus, diphtheria, pertussis (19-64 years)	51	54	49
Pneumococcal (65 years and older)	65	45	40
Pneumococcal (19-64 years, high risk)	18	18	12
Hepatitis B (19-49 years, high risk)	43	44	37
HPV (19-26 years)	20	13	13
Shingles (60 years and older)	11	4	5
Influenza (65 years and older)	69	51	51
Influenza (50-64 years)	42	37	31

The NHIS survey also reported vaccination rates in health care professionals for influenza (up 7 percent, to 53 percent), hepatitis B (up 2.5 percent, to 65 percent) and Tdap (up 1.6 percent, to 58 percent). "It's gratifying to see health care worker vaccination rates continue to increase," said CDC's Melinda Wharton. "By modeling good preventive care behaviors our health care professionals are truly leading the way as good partners in their relationship with patients." The NHIS vaccination data include anyone employed in a health care occupation or setting. In contrast, physician-only vaccination rates are much higher (>90 percent for influenza) as reported in two separate NFID surveys fielded before and during the current influenza season.

Doctor/patient communication breakdown a factor in low vaccination rates

A dramatic physician-patient communication disconnect was revealed by new data from two NFID surveys. Nearly 90 percent of primary care physicians say they discuss vaccines with their patients, yet in a separate survey of consumers, almost half cannot recall ever discussing vaccines with their physicians. As further evidence of the communication gap between physicians and their patients, 99 percent of physicians say that they or their staff initiates vaccine discussions, but just 44 percent of patients say that is true.

"Busy primary care physicians think they're doing a good job recommending vaccines, but the survey indicates that patients aren't getting the message," suggested Dr. Rehm. "Consumers overwhelmingly said they look to physicians for vaccine recommendations and are likely to act on those recommendations, so it's clear that we physicians need to be more effective in communicating with our patients."

Among the positive findings, consumer familiarity with vaccine-preventable illnesses is rising, although still limited. Familiarity with specific vaccine-preventable diseases rose 4 to 12 percent compared with results from a 2009 survey, with the largest increase for pertussis vaccine. The only vaccine-preventable disease not to register an increase in familiarity is pneumococcal vaccine. Consumers also report that they rarely refuse vaccines if their physicians recommend them.

A realized consequence: disease resurgence

The ongoing pertussis epidemic in California demonstrates the danger still posed by diseases once thought to be gone in the U.S. There are reports of more than 6,400 cases so far in California this year, the most since 1958. While pertussis can affect people of any age and in fact, national rates have been rising in adults, it is the infants who adults pass this on to who bear the burden. Ten infants, all younger than three months, have died from whooping cough in California this year.

Patrick Joseph, M.D., a California infectious disease physician who is NFID's vice president, implored adults to get the one-time booster vaccine, "While the epidemic is in adults, the tragedy is in kids. The situation is grave when babies too young to be immunized are dying."

Dr. Joseph said this crisis means California doesn't have the luxury of bringing people along slowly. The time to increase vaccination rates for pertussis is now. The California Department of Public Health recommends pertussis boosters for all adults, including those over 65, a move supported by the CDC's Advisory Committee on Immunization Practices (ACIP). At its October meeting, ACIP voted to extend pertussis booster vaccination recommendations to include adults 65 and older nationwide.

While California has been hardest hit so far, many other areas have seen increased cases this year, including Ohio, South Carolina, Michigan, Texas, Idaho, upstate New York and the Philadelphia suburbs. Since pertussis knows no boundaries, Dr. Joseph voiced his hope that adults outside his home state would also take notice and seek a Tdap vaccine now to protect themselves and infants around them.

Importance of pneumococcal and influenza vaccines also highlighted

AARP board member Catherine Georges, R.N., Ed.D., reminded adults that the time to get an influenza vaccine is now. "We know it's important for Americans of all ages to go out now and get the flu vaccine, but it's even more critical for people 50-plus," said Dr. Georges, a registered nurse and professor and chair of the department of nursing at Lehman College and the Graduate Center at the City University of New York. "Older Americans are often caring for their children and for older loved ones. Getting vaccinated not only protects you, but also helps protect your family and friends." Dr. Georges echoed the universal recommendation from CDC for influenza vaccination of all Americans six months and older.

Since pneumococcal infection is an all too frequent complication of influenza, Dr. Georges reminded Americans that, "pneumococcal and influenza vaccines can be given at the same medical visit." Pneumococcal vaccine is recommended for everyone 65 and older and for younger adults with certain risk factors or conditions like asthma, smoking, heart disease and diabetes. For most people, pneumococcal is a one-time vaccination.

Alarmingly few Americans immunized against debilitating disease of shingles

The lowest vaccination rate for a routinely recommended vaccine is for the shingles vaccine, which is recommended for everyone starting at age 60. Only ten percent of eligible persons have received the shingles vaccine. Not only does the likelihood of getting shingles increase with age, so does the severity of shingles pain, which can last long after the shingles rash has disappeared (this pain is known as post-herpetic neuralgia, or PHN). This pain diminishes quality of life and functional capacity as much as congestive heart failure, a heart attack, type II diabetes or major depression.

Adults in the NFID survey say they are familiar with shingles, but further questioning reveals knowledge gaps; for instance, 42 percent do not know that anyone who has had chickenpox is at risk for shingles. Still, adults are aware of the pain of the disease; 55 percent say they "know someone who has had it and it was terrible." Unfortunately, only half of adults even know there is a shingles vaccine available and just 16 percent know it is currently recommended for everyone 60 and older.

"Shingles can be a terribly painful and debilitating disease, particularly in the elderly," said Jeffrey Cohen, M.D., chief of the Laboratory of Infectious Disease at the National Institute of Allergy and Infectious Diseases. "Shingles pain can be very difficult to treat. Current therapies are only somewhat effective and often associated with frequent and problematic side effects, especially in older people, which is why it is vitally important that we educate Americans about the vaccine."

Vaccines prevent cancer

"Human papillomavirus (HPV) not only causes cervical cancer, but also a growing portion of head and neck cancers," according to Maura Gillison, M.D., Ph.D, Jeg Coughlin Chair of Cancer Research at the Ohio State University College of Medicine. "Twenty years ago about 40 percent of these cancers were due to HPV; today that number is over 60 percent in the U.S. Even more alarming is that these cancers are happening in younger people without traditional risk factors—smoking and alcohol consumption."

The hepatitis B vaccine also protects against certain cancers. The hepatitis B virus causes 30 percent of all liver cancers in the U.S. and doubles the risk of non-Hodgkin's lymphoma. Both HPV and hepatitis B viruses are common. An estimated 70 percent of Americans will be infected with HPV in their lifetime and up to 1.4 million Americans have chronic hepatitis B infection.

CDC recommends HPV vaccine for all women 19 to 26 years of age if not previously vaccinated and recommends the hepatitis B vaccine for all sexually active adults who are not in a long-term, mutually monogamous relationship and others in more defined risk groups.

"I urge everyone to get the HPV and hepatitis B vaccines as recommended," said Dr. Gillison. "These vaccines are truly life-saving. As a cancer-specialist, I can tell you that prevention is a far better option than treatment. These are not cancers you want to have or want your kids to have."

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National Meningitis Association Statement on Advisory Committee on Immunization Practices Vote

/PRNewswire/ -- On October 27, 2010, the CDC's Advisory Committee on Immunization Practices (ACIP) voted to expand the adolescent meningococcal vaccination recommendation to include a booster. Routine vaccination at age 11-12 years continues to be recommended with a booster dose at age 16. For adolescents who are first vaccinated between 13 and 15 years of age, a booster dose is recommended 5 years after the first dose through age 21.

NMA Statement:

The National Meningitis Association supports ACIP's decision to maintain meningococcal immunization at age 11-12 and to add a booster dose to provide increased prevention of disease among adolescents throughout their high-risk years. This is a good public health decision that will protect our children from meningococcal disease.

We looked forward to supporting this recommendation as well as the adolescent immunization platform through our education and outreach programs.

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HHS announces $30 million in new resources to support the National HIV/AIDS Strategy

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today(September 24) announced that CDC has allocated $30 million of the Affordable Care Act's Prevention and Public Health Fund to expand HIV prevention efforts under the President's National HIV/AIDS Strategy (NHAS). This includes $21.6 million in grants to state and local health departments. The funding will help to further focus HIV prevention on high risk populations and communities, as well as fill critical gaps in data, knowledge and understanding of the epidemic.

"This funding will give a critical boost to our HIV/AIDS prevention efforts across the country," said Secretary Kathleen Sebelius. "By focusing on communities and geographic areas that have been hardest hit by this disease, these critical investments will make a real impact on prevention efforts - a key part of the National HIV/AIDS Strategy."

"The National HIV/AIDS Strategy gives us an opportunity to redefine our nation's approach to HIV prevention, and can help us take our collective efforts to the next level," said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "We are pleased that this funding will allow those of us working in HIV prevention at the federal, state, and local level to support innovative, evidence-based and high-impact prevention efforts in line with recommendations from the strategy."

Grants totaling $11.6 million will support demonstration projects to identify and implement a "combination approach" to enhance effective HIV prevention programming in 12 hard-hit areas across the country. These efforts will both supplement existing programs in these communities and help jurisdictions to better focus efforts on key at-risk populations and fulfill unmet needs.

Under this program, each funded jurisdiction will work with CDC to determine what mix of HIV prevention approaches can have the greatest impact in the local area - at the individual, population, and community level - based on the local profile of the epidemic and by assessing and identifying current gaps in HIV prevention portfolios. While the exact combination of approaches will vary by area, efforts funded under this program will follow a basic approach of: intensifying prevention for individuals at greatest risk, along with testing those individuals to reduce undiagnosed HIV infection; prioritizing prevention and linkage to care for people living with HIV; and directing these intensified efforts to communities with the highest burden of HIV.

The twelve jurisdictions funded in the first year for these efforts include Chicago, the District of Columbia, Florida, Georgia, Houston, Los Angeles, Maryland, New York City, Philadelphia, Puerto Rico, San Francisco, and Texas. The average award is approximately $960,000

Additional funding will allow CDC to expand upon successful existing efforts, as well as fill knowledge gaps to help guide evidence-based policies and approaches as a part of NHAS. Awards to state and local health departments include:

* Increasing HIV testing: $4.4 million from the Affordable Care Act will allow CDC to further expand its successful HIV testing initiative. The initiative began in 2007 to increase knowledge of HIV status primarily among African Americans, and was recently expanded to reach more hard-hit communities and populations at risk, including Latinos, men who have sex with men (MSM), and injection drug users. In the first two years of the program alone, more than 1.4 million Americans were tested, and more than 10,000 individuals were newly diagnosed.

* Filling critical data gaps: $5.6 million from the Affordable Care Act will enhance local area data collection, to provide critical information to better monitor and target future HIV prevention and treatment programs. Specifically, the new funds allow areas to monitor disease indicators among HIV-infected populations to better understand access to care, prevention, and treatment services.

The remainder of the funding is going to support additional activities for HIV prevention:

* Supporting evaluation for new activities: $6.6 million from the Affordable Care Act will support evaluation and monitoring of combination prevention approaches and other activities. Funding will also establish a web-based survey to quickly identify and respond to trends in risk behavior and exposure to HIV prevention services among men who have sex with men (MSM.)

* Prioritizing underserved populations: $1 million from the Affordable Care Act will support work with tribal communities to improve HIV prevention and program integration for American Indians/Alaska Natives.

While the exact eligibility criteria differed for each of the awards, the majority of the funding is directed toward geographic areas hard hit by the epidemic.

"While this funding represents an exciting new investment in HIV prevention, these efforts are just one important part of what is needed to implement the National HIV/AIDS Strategy and address the devastating impact that the epidemic has on many communities in the United States," said Dr. Jonathan Mermin, director of CDC's Division of HIV/AIDS Prevention. "Success will require a shared commitment and responsibility across the board, from CDC and other parts of the federal government and beyond. With far too many new infections occurring here each year - one new infection every nine and a half minutes - we must work together to ensure that the urgent HIV prevention needs in this country are met."

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Sebelius announces $42.5 million for public health improvement programs through the Affordable Care Act

$399,836 to Georgia State Department of Community Health

U.S. Department of Health and Human Services Secretary Kathleen Sebelius today (September 20) announced that the Centers for Disease Control and Prevention (CDC) has awarded funding for 94 projects totaling $42.5 million to state, tribal, local and territorial health departments to improve their ability to provide public health services. This funding, made possible through the new Prevention and Public Health Fund created by the Affordable Care Act, will be distributed through cooperative agreements to 49 states, eight federally recognized tribes, Washington, D.C., nine large local health departments, five territories, and three Affiliated Pacific Island jurisdictions to maximize public health efforts.

“These funds will help health departments around the country to improve the quality and effectiveness of the critical health services that millions of Americans rely on every day,” said Secretary Sebelius. “Strengthening our public health system through better coordination and collaboration will help to deliver higher quality health care more efficiently.”

This new 5-year cooperative agreement program entitled, Strengthening Public Health Infrastructure for Improved Health Outcomes, will provide health departments with needed resources to make fundamental changes in their organizations and practices, so that they can improve the delivery of public health services including:

- Building and implementing capacity within health departments for evaluating the effectiveness of their organizations, practices, partnerships, programs and use of resources through performance management

- Expansion and training of public health staff and community leaders to conduct policy activities in key areas and to facilitate improvements in system efficiency

-Maximizing the public health system to improve networking, coordination, and cross-jurisdictional cooperation for the delivery of public health services to address resource sharing and improve health indicators

-Disseminating, implementing and evaluating public health’s best and most promising practices

- Building a national network of performance improvement managers that share best practices for improving the public health system.

“Investing in public health builds a foundation for a strong and healthy society and contributes to lowering the cost of health care. Investing in proven preventive services and strong policies helps us to avoid unnecessary costs later,” said CDC Director Thomas R. Frieden, M.D., M.P.H.

“These funds are a down payment on improving public health services across the nation,” said Dr. Judith A. Monroe, CDC’s deputy director for state, tribal, local and territorial support. “With these funds, we will help our nation’s public health departments work more effectively and efficiently to detect and respond to public health problems. This program will strengthen the nation’s public health system and our ability to improve the health and well being of all Americans.”

In response to the CDC’s original funding announcement Public Health Systems and Infrastructure projects in July 2010, CDC received more than 140 applications from health departments seeking funds through this cooperative agreement. For more information, please visit http://www.cdc.gov/ostlts

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CDC: Two-Thirds of Emergency Visits Occur During Non-Business Hours; Percentage of Non-Urgent Emergency Patients Drops To Less than 8 Percent

/PRNewswire/ -- A new report from the Centers for Disease Control and Prevention once again debunks the myth that emergency departments are crowded with non-urgent patients, a finding noted by the American College of Emergency Physicians (ACEP).

"The percentage of non-urgent patients dropped to only 7.9 percent in 2007 [from 12.1 percent in 2006]," said Dr. Angela Gardner, president of ACEP. "The report also makes the excellent point that non-urgent does not imply unnecessary. As we have said repeatedly, our patients are in the ER because that's where they need to be.

There were approximately 222 visits to U.S. emergency departments every minute in 2007 (http://bit.ly/9B5kHJ) and the number of visits increased by 23 percent between 1997 and 2007, according to the report. Preliminary data for 2008 indicate that emergency visits will increase to a record high of more than 123 million (http://bit.ly/ak6oRx).

The report, "National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary" offers far more detail than the data brief released by the Centers for Disease Control and Prevention (CDC) in May. The U.S. Department of Health and Human Services, of which the CDC is a part, has indicated that this is the last fully detailed report of its kind to be issued about emergency department visits.

Dr. Gardner is urging the CDC to reconsider:

"It is essential to know what is happening in our emergency departments as we implement health care reform. This report is rich in data about who our patients are, how old they are and why they are seeking care in the ER. From a planning perspective, this information is invaluable. It would be a mistake for the CDC to discontinue tracking what is happening on the front lines of healthcare, the nation's emergency departments."

Babies under 12 months old had the highest visit rate at 88.5 visits per 100 infants. The second highest visit rate was by adults age 75 and older, with 62 visits per 100 people.

Approximately one-quarter of all visits were by patients insured by either Medicaid or the State Children's Health Insurance Program. The uninsured represented about 15 percent of all visits.

"Most doctors' offices are open for around 45 hours a week, as opposed to the 168 hours a week emergency departments are open," said Dr. Gardner. "That nearly two-thirds of emergency patients came to the ER between 5 p.m. and 8 a.m. during the week or on weekends highlights the unpredictable nature of health emergencies. When you are the one who has a sick child, the last thing you want is a 'closed' sign or after-hours message."

The report also notes that only 0.1 percent of patients die in the emergency department.

"We do an excellent job of stabilizing and treating our patients, but the persistent problems of overcrowding, ambulance diversion and boarding admitted patients in the ER are not going away," said Dr. Gardner. "We know from the Massachusetts experience that visits will continue to rise with health care reform. We also know that as Baby Boomers age, a tsunami of patients in need of emergency care is just around the corner. We need help and we need it now."

The report says the main issue contributing to overcrowding has been delays in moving the sickest patients to inpatient beds. Admitted patients have often been boarded in the emergency departments or hospital hallways for hours to days, resulting in overcrowding and diversion of incoming ambulances to other hospitals.

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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Arthritis Impacts African-Americans and Hispanics More than Whites

/PRNewswire/ -- Arthritis causes more pain and limitations for African-Americans and Hispanics than for whites, according to a study released today by the Centers for Disease Control and Prevention.

African-Americans were 17 percent less likely to report having arthritis than whites, and Hispanics were 46 percent less likely to report the condition than whites, the study said. However, African-Americans and Hispanics with arthritis were almost twice as likely to report severe joint pain and work limitations attributed to their arthritis when compared to whites, it said.

The study, "Difference in the Prevalence and Impact of Arthritis among Racial / Ethnic Groups," was published in the journal Preventing Chronic Disease.

Arthritis is the leading cause of disability in the United States, affecting 1 in 5 adults. It interferes with work and other daily activities and can complicate the management of other chronic diseases. Arthritis encompasses more than 100 diseases and conditions that affect joints and other connective tissue.

The reason for the racial and ethnic differences, while unknown, may result from a lack of access to health care, language barriers and cultural differences, the report says.

"We must address these stark differences in arthritis impact by using what we know,'' said Jennifer Hootman, an epidemiologist for the CDC National Center for Chronic Disease Prevention and Health Promotion and co-author of the report. "We can educate those with arthritis about increasing physical activity and self-management and reducing obesity, especially those in groups bearing a disproportionate burden from arthritis."

The data, collected from the CDC National Health Interview Survey, are the first to estimate the national prevalence of arthritis and assess its impact among smaller racial and ethnic groups that are usually grouped together when reporting health statistics.

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CDC Study Finds U.S. Herpes Rates Remain High

/PRNewswire/ -- About 1 in 6 Americans (16.2 percent) between the ages of 14 and 49 is infected with herpes simplex virus type 2 (HSV-2), according to a national health survey released today by the Centers for Disease Control and Prevention. HSV-2 is a lifelong and incurable infection that can cause recurrent and painful genital sores.

The findings, presented at the 2010 National STD Prevention Conference, indicate that herpes remains one of the most common sexually transmitted diseases (STDs) in the United States.

The new estimate, for 2005-2008, comes from CDC's National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of the U.S. household population that assesses a broad range of health issues.

The findings suggest relatively stable HSV-2 prevalence since CDC's last national estimate (17 percent for 1999-2004), because the slight decline in prevalence between the two time periods is not statistically significant.

The study finds that women and blacks were most likely to be infected. HSV-2 prevalence was nearly twice as high among women (20.9 percent) than men (11.5 percent), and was more than three times higher among blacks (39.2 percent) than whites (12.3 percent). The most affected group was black women, with a prevalence rate of 48 percent.

As with other STDs, biological factors may make women more susceptible to HSV-2 infection. Additionally, racial disparities in HSV-2 infection are likely perpetuated because of the higher prevalence of infection within African-American communities, placing African-Americans at greater risk of being exposed to herpes with any given sexual encounter.

"This study serves as a stark reminder that herpes remains a common and serious health threat in the United States. Everyone should be aware of the symptoms, risk factors, and steps that can be taken to prevent the spread of this lifelong and incurable infection," said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "We are particularly concerned about persistent high rates of herpes among African-Americans, which is likely contributing to disproportionate rates of HIV in the black community."

Research shows that people with herpes are two to three times more likely to acquire HIV, and that herpes can also make HIV-infected individuals more likely to transmit HIV to others. CDC estimates that over 80 percent of those with HSV-2 are unaware of their infection. Symptoms may be absent, mild, or mistaken for another condition. And people with HSV-2 can transmit the virus even when they have no visible sores or other symptoms.

"Many individuals are transmitting herpes to others without even knowing it," said John M. Douglas, Jr., M.D., director of CDC's Division of STD Prevention. "We can't afford to be complacent about this disease. It is important that persons with symptoms suggestive of herpes -- especially recurrent sores in the genital area -- seek clinical care to determine if these symptoms may be due to herpes and might benefit from treatment."

Combination of Prevention Approaches Needed to Reduce National Herpes Rates

Although HSV-2 infection is not curable, there are effective medications available to treat symptoms and prevent outbreaks. Those with known herpes infection should avoid sex when herpes symptoms or sores are present and understand that HSV-2 can still be transmitted when sores are not present. Effective strategies to reduce the risk of HSV-2 infection include abstaining from sexual contact, using condoms consistently and correctly, and limiting the number of sex partners.

CDC does not recommend HSV-2 screening for the general population. However, such testing may be useful for individuals who are unsure of their status and at high risk for the disease, including those with multiple sex partners, those who are HIV-positive, and gay and bisexual men.

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FDA Commissioner Addresses Nation's Health Care Professionals on H1N1 Vaccine Safety

FDA Commissioner Margaret A. Hamburg today sent a letter to America’s health care professionals thanking them for their efforts during the 2009 H1N1 influenza outbreak and providing information on safety monitoring of the 2009 H1N1 vaccines.

“In November, I wrote to thank you for your efforts during the 2009 H1N1 influenza outbreak and to provide information about the development and FDA approval of the H1N1 vaccines,” Hamburg wrote. “I mentioned our continuing robust efforts to monitor the safety of these vaccines and now would like to reassure you that, to date, the safety assessment is very encouraging.

“As a key part of our missions, the FDA, the Centers for Disease Control and Prevention, other agencies across the Department of Health and Human Services, and other parts of the federal government, including the Department of Defense and the Department of Veterans Affairs, have enhanced and expanded our vaccine safety monitoring systems to detect and quickly investigate any unexpected, rare, or serious adverse events. These additional systems enhance our ability to determine whether any adverse events can be attributed to H1N1 influenza vaccines. A detailed description of vaccine safety efforts is available online at www.flu.gov.

“According to the January 8, 2010 update of FDA and CDC vaccine safety monitoring activities, as of December 30, 2009 the total number of doses of H1N1 vaccines distributed was 99.3 million and the vast majority (94%) of adverse events reported to VAERS were classified as "non-serious" (e.g., soreness at the vaccine injection site). Weekly updates on FDA and CDC vaccine safety monitoring activities are available through the VAERS web site http://vaers.hhs.gov/resources/h1n1update#top.”

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CDC Foundation Launches Viral Hepatitis Action Coalition

/PRNewswire/ -- In anticipation of the release of the Institute of Medicine (IOM) report on viral hepatitis, the CDC Foundation (the independent nonprofit partner of the Centers for Disease Control and Prevention), in partnership with CDC's Division of Viral Hepatitis, recently launched the Viral Hepatitis Action Coalition. The Coalition is comprised of private-sector organizations committed to supporting high priority research, education and program evaluation projects initiated by CDC's Division of Viral Hepatitis. In addition to providing funding for specific projects, Coalition members also will support CDC by sharing research data, connecting CDC to appropriate stakeholders and networks, and providing feedback on the information and tools needed in the field to respond to the recommendations outlined in the IOM report.

Founding Viral Hepatitis Action Coalition members include: Gilead Sciences, Inc.; Merck & Co., Inc.; OraSure Technologies; and Vertex Pharmaceuticals. In addition to supporting the overall Coalition, members will have the opportunity to fund and partner with CDC on CDC-led research and education projects as priorities are identified. Two initial priority projects include a study called Birth-cohort Evaluation to Advance Screening and Testing for Hepatitis C (BEST-C) and a national hepatitis education campaign. For each project, Coalition members will reach out to other critical partners in the hepatitis community as appropriate, including partners from academia, patient advocacy and other hepatitis-related groups. Coalition members are committed to engaging the entire hepatitis community in efforts to improve screening and treatment of viral hepatitis.

The Viral Hepatitis Action Coalition is seeking additional membership, and those interested in membership should contact Leah-Lane Lowe at 404.653.0790 or llowe@cdcfoundation.org. To learn more about CDC's Division of Viral Hepatitis, please visit www.cdc.gov/hepatitis.

Established by Congress, the CDC Foundation is the independent, nonprofit partner of the Centers for Disease Control and Prevention. The CDC Foundation helps CDC do more, faster by forging effective partnerships between CDC and individuals, corporations and foundations to fight threats to health and safety. To learn more, please visit www.cdcfoundation.org.

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CSTE National Assessment Finds Critical Public Health Disease Surveillance Capacity Lacking

/PRNewswire/ -- Today, CDC's Morbidity and Mortality Weekly Report (MMWR) released a report showing that the number of state-level epidemiologists has decreased steadily since 2004, with a marked decline of over 10% since 2006. There was also a substantial decrease in core epidemiology capacity over this same period, including epidemiology capacity for bioterrorism and emergency response. For some important subject areas such as occupational health, substance abuse, and oral health, basic epidemiology capacity in most states is described as minimal to non-existent, and many states still lack the 21st century technology capacity needed for state-of-the-art surveillance. Dr. James Hadler, the lead author of this article, concluded that "The current condition of national epidemiology is a preparedness and public health vulnerability." States indicated a substantial need for more epidemiologists in all program areas. The deterioration of state epidemiology capacity is a consequence of declines in funding for bioterrorism preparedness and emergency response as well as an effect of the economic downturn on state budgets.

CSTE's 2009 Epidemiology Capacity Assessment (ECA) is the most recent in a series of epidemiology capacity assessments that enumerate and characterize epidemiologists, measure core epidemiology capacity, and assess competency-specific training. The 2009 ECA also conducted initial assessments of surveillance system technologic capacity and substance abuse program capacity. The 2009 ECA builds on the previous ECAs of 2004 and 2006. This year's assessment indicates a substantial decline in overall epidemiology capacity across the nation.

Epidemiologists are best known for their "disease detective" work with infectious diseases that are naturally occurring or intentionally released, but they are mainly involved in everyday surveillance/monitoring and study of many diseases and conditions that affect the health of the their state's population. These activities can range from food and waterborne disease investigations to disease monitoring for environmental health conditions, chronic diseases, maternal and child health, injury, occupational and oral health and substance abuse.

"State, federal and local agencies need to work together to address the understaffed epidemiology workforce, the downward trends in capacity and the looming epidemiology workforce shortage. Public health needs to achieve a full, well-trained and competent workforce prepared with the appropriate tools and skills for the 21st century," says co-author Matthew Boulton from the University of Michigan School of Public Health, Center of Excellence in Public Health Workforce Studies. Access to the full report, 2009 Epidemiology Capacity Assessment: Findings and Recommendations, can be found at www.cste.org.

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FDA, CDC, and States Investigating Norovirus Illnesses Linked to Oysters

The U.S. Food and Drug Administration is advising consumers to avoid eating oysters harvested from the San Antonio Bay on or after Nov. 16 due to reports of norovirus-associated illnesses in some people who had consumed oysters harvested from this area, which is located on the Gulf of Texas.

The FDA, along with the Centers for Disease Control and Prevention (CDC) and the states of North Carolina, South Carolina and Texas, are investigating about a dozen reports of norovirus-related illnesses from South Carolina and North Carolina consumers who ate oysters recently harvested from the San Antonio Bay.

Consumers who purchased oysters on or after Nov. 16 that have a label showing they came from San Antonio Bay are advised to dispose of the oysters and not eat them. At restaurants, consumers can ask about the source of oysters offered as menu items. Restaurant operators and retailers should not serve or offer for sale oysters subject to this advisory. Restaurant operators and retailers who are unsure of the source of oysters on hand should check with their suppliers to determine where the oysters were harvested. No other seafood is affected by this advisory.

The Texas Department of State Health Services has ordered a recall of all oysters harvested from the San Antonio Bay between Nov. 16 and Nov. 25.

Noroviruses are a group of viruses that cause gastroenteritis. Symptoms of illness associated with norovirus include nausea, vomiting, diarrhea and stomach cramping. Affected individuals often experience low-grade fever, chills, headache, muscle aches and a general sense of tiredness. Most people show symptoms within 48 hours of exposure to the virus. The illness typically lasts one to two days. Norovirus typically is not life-threatening and does not generally cause long-term effects.

Consumers who ate oyster products on or after Nov.16 and have experienced symptoms of norovirus are encouraged to contact their health care provider and local health department.

The implicated oyster beds in the San Antonio Bay were closed by the Texas Department of Health Services on Nov. 26, 2009, and remain closed.

The FDA and CDC will continue working with health officials in the affected states to track any additional cases of norovirus illness.

Persons with weakened immune systems, including those affected by AIDS, and persons with chronic alcohol abuse, liver, stomach or blood disorders, cancer, diabetes or kidney disease should avoid raw oyster consumption altogether, regardless of where the oysters are harvested.

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Highest Rates of Obesity, Diabetes in the South, Appalachia, and Some Tribal Lands

Wide sections of the Southeast, Appalachia, and some tribal lands in the West and Northern Plains have the nation's highest rates of obesity and diabetes, according to estimates released today by the Centers for Disease Control and Prevention. In many counties in those regions, rates of diagnosed diabetes exceed 10 percent and obesity prevalence is more than 30 percent.

The estimates, in this week's Morbidity and Mortality Weekly Report, are the first to provide county-level snapshots of obesity across the United States. They also update diabetes county-level estimates released in 2008.

Eighty-one percent of counties in the Appalachian region that includes Kentucky, Tennessee, and West Virginia have high rates of diabetes and obesity. So do three-quarters of counties in the southern region that includes Alabama, Georgia, Louisiana, Mississippi, and South Carolina.

"Diabetes is costly in human and economic terms, and it's urgent that we take action to prevent and control this serious disease," said Dr. Ann Albright, director of CDC's Division of Diabetes Translation. "The study shows strong regional patterns of diabetes and can help focus prevention efforts where they are most needed."

The estimates come from the agency's Behavioral Risk Factor Surveillance System (BRFSS), which uses self-reported data from state-based adult telephone surveys, and 2007 census information. The information may help public health workers, health care providers, community organizations, and policymakers focus on high-risk regions to prevent type 2 diabetes and its complications as well as other chronic diseases linked to obesity, including heart disease, stroke, and some cancers.

The proportion of U.S. adults who are obese was 26.1 percent in 2008, according to BRFSS data. CDC estimates that nearly 8 percent of the population, or about 24 million people, have diabetes. Of these, 5.7 million are undiagnosed.

"The small-area estimates for obesity will be an important tool to help communities better understand and battle this serious public health problem. Communities are in the best position to prevent and reduce obesity among their citizens through innovative programs," said Dr. William H. Dietz, director of CDC's Division of Nutrition, Physical Activity and Obesity.

The medical costs of obesity reached an estimated $147 billion in 2008, and the medical costs of diabetes were $116 billion. People with diagnosed diabetes have medical costs that are 2.3 times higher than those without the disease.

Obesity is one of several factors linked to type 2 diabetes. Where people live, how much money they earn, their culture and their family history also play a role. An unhealthy diet, lack of physical activity, and socioeconomic factors contribute to both obesity and type 2 diabetes as well as to complications of diabetes. Some population groups also are at higher risk, including a number of racial and ethnic minorities.

CDC and its partners are working on a variety of initiatives to prevent type 2 diabetes and to reduce obesity. CDC has recommended 24 community strategies to prevent obesity, from providing greater access to healthy foods to redesigning communities to encourage more physical activity. The agency is also in a new partnership with state, federal, and nonprofit agencies targeting health disparities in Mississippi, which has the nation's highest obesity rate and one of the highest rates of diabetes. CDC's national diabetes prevention and control program provides resources and technical assistance to state health departments, national organizations, and communities.

To see county-level estimates of obesity and diagnosed diabetes, go to www.cdc.gov/diabetes/statistics. For more information on diabetes and preventing the disease, visit www.cdc.gov/diabetes. To learn more about CDC s efforts in the fight against obesity or for more information about nutrition, physical activity, and maintaining a healthy weight, go to www.cdc.gov/obesity/index.html.

/PRNewswire-USNewswire

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Fewer U.S. Schools Selling Less Nutritious Food and Beverages

/PRNewswire/ -- Fewer secondary schools in the United States are selling less nutritious foods and beverages, such as candy and soda, according to a survey from the Centers for Disease Control and Prevention.

The greatest improvements were seen in states that have adopted strong school nutrition standards and policies for foods and beverages sold outside school meal programs.

The report, "Availability of Less Nutritious Snack Foods and Beverages in Secondary Schools - Selected States, 2002-2008," was published today in CDC's Morbidity and Mortality Weekly Report.

The report shows that among the 34 states that collected data in 2006 and 2008, the median percentage of secondary schools that did not sell soda or fruit drinks that are not 100 percent juice increased from 38 percent to 63 percent. The median percentage of secondary schools in these states that did not sell candy or salty snacks not low in fat increased from 46 percent in 2006 to 64 percent in 2008.

"The school environment is a key setting for influencing children's food choices and eating habits," said Howell Wechsler, Ed.D, M.P.H., director of CDC's Division of Adolescent and School Health. "By ensuring that only healthy food options are available, schools can model healthy eating behaviors, help improve students' diets, and help young people establish lifelong healthy eating habits."

Mississippi and Tennessee made the greatest progress in improving the nutrition environment in their schools. In Mississippi, the percentage of secondary schools that did not sell soda or fruit drinks that are not 100 percent juice increased from 22 percent in 2006 to 75 percent in 2008, while in Tennessee the percentage increased from 27 percent to 74 percent. These two states are national leaders in implementing strong statewide school nutrition standards.

"Efforts to improve the school nutrition environment are working, and Mississippi and Tennessee are excellent examples of this progress. However, there are still far too many schools selling less nutritious foods and beverages," said Wechsler.

The School Health Profiles Survey is conducted among a representative sample of secondary schools in a state, large urban school district, or territory. The data are collected from self-administered questionnaires from the principal and the lead health education teacher at each sampled school. The 2008 report includes data from 47 states, 20 cities, and four territories.

The 2008 study results varied dramatically across states.
-- In Hawaii, Connecticut, California, and Maine, more than two-thirds of
secondary schools did not sell baked goods, salty snacks not low in
fat, candy, soda or fruit drinks that were not 100 percent juice.

-- In Utah, Kansas, Idaho, and Nebraska, less than one-third of secondary
schools did not sell these items.

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CDC Awards $22 Million for Colorectal Cancer Screening Program

The Centers for Disease Control and Prevention (CDC) has awarded a total of $22 million to 26 states and tribal organizations to provide colorectal cancer screening services for low-income people aged 50-64 years, who are underinsured or uninsured. Colorectal cancer is the second leading cause of cancer deaths among men and women aged 50 and older in the United States.

The awards range from $358,283 to $1.1 million. The awardees are expected to begin screening patients for colorectal cancer within six months.

The states receiving five-year awards are: Alabama, Arizona, California, Colorado, Connecticut, Delaware, Florida, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, New York, Oregon, Pennsylvania, South Dakota, Utah, and Washington. The tribal organizations receiving awards are: Alaska Native Tribal Health Consortium, Arctic Slope Native Association, South Puget Intertribal Planning Agency, and Southcentral Foundation.

The funding will support screening and diagnostic follow-up care, data collection and tracking, public education and outreach, provider education, and an evaluation to measure the clinical outcomes, costs, and effectiveness of the program. The awardees can choose from among any of the recommended screenings for colorectal cancer - colonoscopy, sigmoidoscopy and stool testing.

"Colorectal cancer kills more people than any other cancer except lung cancer," said CDC Director Thomas Frieden, M.D., M.P.H. "These colorectal cancer screening awards will save lives. We need to reach more adults aged 50 and over and others at high risk to prevent colorectal cancer."

In 2005, more than 141,000 new cases of colorectal cancer were diagnosed and 53,000 people died from this disease. The number of new colorectal cancer cases could be reduced by as much as 90 percent if all precancerous polyps (abnormal growths in the colon or rectum), were identified using screening tests and removed before they become cancerous. However, only half of all U.S. adults aged 50 or older have been screened appropriately for colorectal cancer, and while screening rates are slowly increasing, disparities still exist. Screening rates remain higher for whites compared to all other races, for non-Hispanics compared to Hispanics, and for people with health insurance compared to those with no health insurance.

"Screening tests can detect colorectal cancer at its earliest stages, when it is most treatable," said Laura Seeff, M.D., medical director of CDC's colorectal cancer screening program. "This screening program has tremendous potential to address the disparities that exist in colorectal cancer screening and to save lives."

The goals of CDC's colorectal cancer screening program are to increase population-level screening among all persons aged 50 and older in the participating states and tribes, and to reduce health disparities in colorectal cancer screening, incidence and mortality.
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CDC to Distribute $40 Million in Recovery Act Funding to Help States Fight Healthcare-Associated Infections

Money marks first time Congress appropriates HAI prevention funds specifically to states

The Centers for Disease Control and Prevention today announced plans to distribute $40 million to state health departments to help prevent healthcare-associated infections (HAIs). Funded by the American Recovery and Reinvestment Act, the money will be distributed through cooperative agreements to 49 states, Washington, D.C., and Puerto Rico to maximize prevention efforts such as:

* Creating or expanding state and local efforts to implement recommendations in the U.S. Department of Health and Human Services HAI Action Plan

* Increasing health care facilities' and health departments' use of CDC's National Healthcare Safety Network, a surveillance system that allows HAI data to be tracked, analyzed and compared for prevention efforts

* Hiring and training public health staff to promote and lead HAI prevention initiatives

* Complementing HAI investments from other HHS agencies

"Americans expect to get better when they go to the hospital, not worse" said HHS Secretary Kathleen Sebelius. "Unfortunately, every year, thousands of Americans die from illness they contract after they enter the hospital. Thanks to Chairman David Obey's leadership, the Recovery Act includes critical resources that will help fight these infections and keep patients safe."

Efforts will focus on HHS priority targets such as bloodstream infections, surgical site infections and catheter-associated urinary tract infections, and will address pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff). The investment represents the first time Congress has appropriated HAI prevention funds specifically to states.

"We expect these programs to strengthen tracking and prevention of healthcare-associated infections, enhance facility accountability, provide data for informed policy, and ultimately save lives," said CDC Director Thomas R. Frieden, M.D., M.P.H. "Funding critical prevention efforts at state and local levels represents a significant investment toward elimination of HAIs and improved patient safety."

CDC estimates that every year, Americans contract 1.7 million infections while being treated in hospitals. These infections are associated with approximately 99,000 deaths annually. In addition to the significant toll on patients' lives, HAIs represent an estimated $30 billion in added healthcare costs.

HHS has addressed HAIs by coordinating efforts across the Department and creating the HHS action plan which includes five-year national prevention targets to reduce and prevent much of the significant burden to our nation. One of the goals of the HHS Action Plan is to collaborate effectively with public and private sector partners to accomplish the large-scale prevention of HAIs.

For instance, CDC is collaborating with several states that have demonstrated that implementing CDC's HAI prevention guidelines and using NHSN to monitor progress can achieve major decreases in HAIs.

Prevention success can be characterized in a number of ways. Some states have shown quick reductions after implementing prevention efforts, and others have sustained low infection rates over an extended period of time. For example, in the first six months of 2009, compared to 2008, hospitals in Tennessee achieved a 30 percent reduction of bloodstream infections associated with central lines (a catheter, or tube, that is inserted into a major vein or artery, and that ends up close to or in the heart). In another instance, intensive care units in a New York state hospital group achieved a 70 percent reduction of central line-associated bloodstream infections and sustained these rates for a three-year period.

"Many states and localities have lacked the resources and personnel needed to appropriately address the HAI burden," said Marion Kainer, M.D., M.P.H., director of the Tennessee Department of Health Hospital Infection and Antimicrobial Resistance Program, and HAI prevention lead for the Council of State and Territorial Epidemiologists. "This investment will provide a unique opportunity to make prevention of HAIs a national accomplishment."

Background on HAI Investments in the Recovery Act

The American Recovery and Reinvestment Act of 2009, Public Law 111-5 (ARRA) was signed into law on February 17, 2009. Within the Recovery Act, $50 million was appropriated to support states in the prevention and reduction of healthcare associated infections (HAI). The Centers for Medicare & Medicaid Services (CMS) will use $10 million to improvethe process and frequency of inspections for ambulatory surgical centers, while CDC will allocate $40 million to states to create or expand state-based HAI prevention collaboration efforts, enhance state abilities to monitor and track HAIs, and build within health departments a workforce trained in HAI prevention. For more information on the Recovery Act: www.recovery.gov. For more information about CDC's HAI Recovery Act funding: www.cdc.gov/hai/recoveryact.
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Immunization Rates Remain Stable at High Levels Among the Nation′s 19- Through 35-Month-Old Children

Childhood immunization rates in the United States remain stable at high levels, according to data from CDC′s 2008 National Immunization Survey (NIS) published in this week′s Morbidity and Mortality Weekly Report (MMWR).

“Vaccination is one of the most important things parents can do to protect their children′s health,” said Dr. Melinda Wharton, Deputy Director, National Center for Immunization and Respiratory Diseases. “Thanks to the hard work of doctors and nurses and other immunization providers and the commitment of parents, rates are still high, but we must all continue to work hard to reach those children who are not fully vaccinated.”

The 2008 NIS included children aged 19–35 months and born during January 2005–June 2007.

Among these children, coverage was 76.1 percent with the 4:3:1:3:3:1 series of vaccines, not a statistically significant difference from the 2007 estimate of 77.4 percent. The national goal for coverage with the 4:3:1:3:3:1 series is 80 percent.

Vaccines in the series are:

* Four or more doses of diphtheria, tetanus and pertussis vaccine (DTaP)
* Three or more doses of polio vaccine
* One or more doses of measles, mumps and rubella vaccine (MMR)
* Three or more doses of Haemophilus influenzae type b vaccine (Hib)
* Three or more doses of hepatitis B vaccine
* One or more doses of varicella (chickenpox) vaccine

For each vaccine in the series, the goal is 90 percent and this was met, except for four doses of DTaP vaccine, which was 84.6 percent.

The 2008 NIS data showed a small but statistically significant decrease nationally for coverage with the Hib vaccine. In 2007, coverage with three or more doses of Hib was 92.6 percent and in 2008 coverage was 90.9 percent. This decrease is likely due to a shortage of the vaccine that began in December 2007 and a temporary recommendation to defer the booster dose. At least 8 percent of the children in the survey were likely impacted by this recommendation. More vaccine became available this summer, and the booster dose is now being recommended again for children at age 12–15 months.

In 2008, coverage with three or more doses of doses of pneumococcal conjugate vaccine (PCV7) increased from 90.0 percent to 92.8 percent and coverage with four or more doses increased from 75.3 percent to 80.1 percent.

As in previous years, estimated vaccination coverage levels varied substantially among states and local areas. 4:3:1:3:3:1 state coverage ranged from 59.2 percent in Montana to 82.3 percent in Massachusetts. Coverage also varied among the 17 local areas surveyed, from 68.5 percent in Northern California to 80.9 percent Santa Clara County, Calif.

This is the first NIS report to include coverage for two or more doses of hepatitis A vaccine, which was 40.4 percent. This report also includes coverage among newborns with the first dose of the hepatitis B vaccine, which was 55.3 percent, an increase from 53.2 percent in 2007.

The proportion of children who had received no vaccine doses remained at 0.06 percent.

Among racial/ethnic groups, little variation in coverage was observed. Coverage for most vaccines remained lower for children living below poverty than children living at or above poverty. Sustaining high coverage levels and finding effective methods of reducing disparities across states/local areas and income groups remains a priority to fully protect children and limit the incidence of vaccine-preventable diseases in the United States.

The NIS is an ongoing random-digit dialed survey of households with children aged 19-35 months. It also includes a mail survey of the children′s vaccination providers to collect vaccination information. During 2008, 18,430 children with provider-reported vaccination records were included in this report.

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FDA Launches New Center for Tobacco Products

The U.S. Food and Drug Administration today launched its new Center for Tobacco Products in an historic effort to curb the hundreds of thousands of deaths caused by those products each year.

The Center will oversee the implementation of the Family Smoking Prevention and Tobacco Control Act signed by President Obama in June 2009. The FDA’s responsibilities under the law include setting performance standards, reviewing premarket applications for new and modified risk tobacco products, and establishing and enforcing advertising and promotion restrictions.

Lawrence Deyton, M.D. M.S.P.H., an expert on veterans’ health issues, public health, tobacco use, and a clinical professor of medicine and health policy at George Washington University School of Medicine and Health Sciences, will serve as the Center’s first director.

“We are thrilled to announce Dr. Deyton’s appointment as director of the Center for Tobacco Products and look forward to him joining the agency,” said FDA Commissioner Margaret A. Hamburg, M.D. “He is the rare combination of public health expert, administrative leader, scientist, and clinician.”

Before coming to the FDA, Deyton was Chief Public Health and Environmental Hazards Officer for the U.S. Department of Veterans Affairs. His responsibilities there included oversight of the VA’s public health programs including tobacco use, the health of women veterans, the long-term health consequences of military service, and the VA’s emergency preparation and response. He was selected after a national search.

The FDA’s Center for Tobacco Products, located on the FDA’s White Oak Campus in Silver Spring, Md., will use the best available science to guide the development and implementation of effective public health strategies to reduce the burden of illness and death caused by tobacco products.

To implement the program, the FDA will start with $5 million from the fiscal year 2009 budget to establish the necessary administrative functions for the Center. As set forth in the Family Smoking Prevention and Tobacco Control Act, funding for the Center and other activities related to the regulation of tobacco will come from user fees paid by manufacturers and importers of tobacco products.

According to the Centers for Disease Control and Prevention, cigarette smoking causes an estimated 438,000 deaths, or about 1 of every 5 deaths, each year. On average, adults who smoke cigarettes die 14 years earlier than nonsmokers.

“As many Americans know, freedom from tobacco dependence is the key to a healthy future,” said Assistant Secretary for Health Howard Koh, M.D., M.P.H. “Dr. Deyton’s public health and tobacco cessation experience will be invaluable as the Department of Health and Human Services and the Food and Drug Administration take on this challenge.”

One of Deyton’s priorities had been revitalization of the VA’s smoking and tobacco use cessation programs. Under his leadership, current smoking among veterans enrolled in the cessation program fell from 33 percent in 1999 to 22 percent in 2007. The VA health care system is the largest integrated provider of health care and medical services in the United States, with more than 1,400 sites serving nearly 6 million veterans in fiscal year 2008.

“I am eager for the challenge of leading the tobacco team at FDA,” said Deyton. “This is a tremendous opportunity for us at FDA to work hand-in-hand with the CDC, researchers at the National Institutes of Health, and public health leaders in the states to make progress in combating tobacco use – the leading cause of preventable death in the United States.”

In 2002, Deyton established the VA’s Public Health Strategic Health Care Group, which encompassed responsibilities for HIV, hepatitis C, tobacco use cessation, bioterrorism, and issues such as SARS, pandemic influenza, and other emerging public health threats. He became Chief Officer in January 2006 and since then has been successful in efforts to address the health needs of veterans.

Deyton has served for 11 years in leadership positions in the National Institute of Allergy and Infectious Diseases at NIH, six years in the Office of the Assistant Secretary for Health at HHS, and as a legislative aide with the House of Representatives Subcommittee on Health and the Environment in the 1970s.

He was a founder in 1978 of the Whitman Walker Clinic, a community based AIDS service organization in Washington, D.C. He is a graduate of Kansas University, the Harvard School of Public Health and the George Washington University School of Medicine. Deyton’s post-doctorate medical training was at the University of Southern California/Los Angeles County Medical Center. He is board certified in Internal Medicine and continues to care for patients on a regular basis.

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Federal Guidelines Encourage Employers to Plan Now for Upcoming Influenza Season

Recommendations Range from Encouraging Hand Washing to Allowing Some Employees to Stay Home

Department of Commerce (DOC) Secretary Gary Locke, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, and Homeland Security (DHS) Secretary Janet Napolitano today announced new guidance for businesses to plan for and respond to the upcoming flu season.

The guidance, released by the Centers for Disease Control and Prevention (CDC), is designed to help employers prepare now for the impact of seasonal and 2009 H1N1 influenza could have this fall and winter on their employers and operations.

Employers' plans should address such points as encouraging employees with flu-like symptoms or illness to stay home, operating with reduced staffing, and possibly having employees who are at higher risk of serious medical complications from infection work from home, according
to the CDC guidance.

It is not known whether the 2009 H1N1 influenza virus will cause more illness or more severe illness in the coming months, but the CDC recommends that everyone be prepared for influenza. Because seasonal and 2009 H1N1 influenza pose serious health threats, employers should
work with employees to develop and implement plans that can reduce the spread of flu, and to encourage seasonal flu vaccination as well as H1N1 vaccination when that vaccine becomes available.

Secretary Locke suggested businesses set the right tone in the workplace. That means implementing common sense measures to reduce the risk of spreading the flu and encouraging workers who are sick to stay home.

"The President has mobilized the federal government to get America prepared," DOC Secretary Locke said. "But government can't do it alone. For this effort to be successful, we need the business community to do its part." Making the right decisions will not only improve public
health, it also has the potential to protect economic productivity: Employees who are sick and stay home will not spread the flu in the workplace.

"This new guidance will help our private sector partners continue to prepare for the upcoming flu season to keep our economy functioning and our critical infrastructure secure," said DHS Secretary Napolitano. "Ensuring business continuity is important to our cooperative efforts to
keep Americans safe."

There are many actions that can be taken to help reduce the spread of flu. The guidance notes the importance of using these actions, including regular and frequent hand washing and routine cleaning of commonly touched surfaces.

"One of the most important things that employers can do is to make sure their human resources and leave policies are flexible and follow public health guidance,'' said HHS Secretary Kathleen Sebelius. ``If employees are sick, they need to be encouraged to stay home. If people begin to
experience flu-like symptoms at work, they should be sent home and possibly encouraged to seek medical treatment. ''

Employers should review sick leave policies and ensure employees understand them, according to the guidance. Employers should try to make sick leave policies flexible for workers who may have to stay home with ill family members or if a child's school is closed, the CDC says.

Employers should consider offering vaccine against seasonal flu, and encourage employees to be vaccinated against seasonal and H1N1 flu, the guidance says.

Employers also might cancel non-essential face-to-face meetings and travel, and space employees farther apart, the report says. And employees who are at higher risk for flu complications might be allowed to work from home or stay home if the flu is severe, it says.

"Keeping our nation's workers safe is a top priority," said Deputy Secretary of Labor Seth Harris, who participated in the announcement. "Faced with a renewed H1N1 challenge during the coming flu season, we are developing tools that will help ensure America's workers stay
healthy and our businesses remain viable."

For more information, visit www.flu.gov.

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Study Estimates Medical Cost of Obesity May Be As High as $147 Billion Annually

/PRNewswire-USNewswire/ -- The health cost of obesity in the United States is as high as $147 billion annually, based on a new study from Research Triangle Institute and the Centers for Disease Control and Prevention. The study, which appeared online July 27 in the journal Health Affairs, was released at CDC's Weight of the Nation conference in Washington, D.C.

The proportion of all annual medical costs that are due to obesity increased from 6.5 percent in 1998 to 9.1 percent in 2006, the study said. This total includes payment by Medicare, Medicaid, and private insurers, and includes prescription drug spending. Overall, persons who are obese spent $1,429 (42 percent) more for medical care in 2006 than did normal weight people. These estimates were compiled using national data that compare medical expenses for normal weight and obese persons.

The study is titled "Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates." Recognizing the large health and economic burden of obesity, CDC has issued its first comprehensive set of evidence-based recommendations to help communities tackle the problem of obesity through programs and policies that promote healthy eating and physical activity.

The report, "Recommended Community Strategies and Measurements to Prevent Obesity in the United States," along with a companion implementation guide, appears in CDC's MMWR Recommendations and Reports. A companion implementation guide is also available on the CDC Web site.

"It is critical that we take effective steps to contain and reduce the enormous burden of obesity on our nation," said CDC Director Thomas Frieden, M.D., M.P.H. "These new recommendations and their proposed measurements are a powerful and practical tool to help state and local governments, school districts, and local partners take necessary action."

The Common Community Measures for Obesity Prevention Project was guided by a systematic process that included expert opinion and a review of the published scientific literature, resulting in the adoption of 24 recommended environmental and policy level strategies to prevent obesity.

The strategies promote the availability of affordable healthy food and beverages, support healthy food and beverage choices, encourage breastfeeding, encourage physical activity or limit sedentary activity, support safe communities that support physical activity, and encourage communities to organize for change.

"Obesity is a risk for a number of chronic diseases, including diabetes, cardiovascular disease, and some cancers," said William H. Dietz, M.D., Ph.D., director of CDC's Division of Nutrition, Physical Activity and Obesity. "Reversing this epidemic requires a multifaceted and coordinated approach that uses policy and environmental change to transform communities into places that support and promote healthy lifestyle choices for all people."

CDC partnered with the International City/County Management Association to pilot test an initial set of obesity prevention measures in 20 communities. The resulting 24 recommended strategies and suggested measures are now being pilot tested by Minnesota and Massachusetts state health departments in order to determine their success. The strategies include:

-- Communities should support locating schools within easy walking
distance of residential areas.

-- Communities should improve availability of affordable healthier food
and beverage choices


The community measures project is a collaborative effort among CDC, the Robert Wood Johnson Foundation, the Kellogg Foundation, Kaiser Permanente, and the CDC Foundation. ICF Macro serves as the coordinating center for the project and the international City/County Management Association pilot tested the measures for each strategy in 20 communities.

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