Biological Terrorism

In the aftermath of the September 11, 2001 attacks and the subsequent mail-borne anthrax attack of October 2001, it has become dear that health care providers may be called upon to respond to victims of terrorism. Biological terrorism (BT), in particular, involves the use of virulent agents with the intent to cause mass casualties and/or induce fear, a scenario that if effected will severely strain the capacity of regional emergency medical services and pose unique management challenges to clinicians confronted with victimized children. Whether practicing as a pediatric emergency medicine specialist working in an urban children's hospital or as a general clinician in private office-based practice, pediatricians may be the first to suspect that a BT agent may have been utilized. Compared to adults, most caregivers have a relatively low threshold for having children and infants evaluated professionally when they become sick. Furthermore, pediatric patients may have a more rapid or severe response to a biological agent, potentially putting pediatricians and child care providers in the critical position of being the first to diagnose an exposure. The clinician's response to such a situation may determine whether the incident is controlled promptly or whether it evolves into a large-scale epidemiologic catastrophe

Guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis

This report updates and consolidates all previous U.S. Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV). Recommendations for HBV postexposure management include initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person who sustains an occupational blood or body fluid exposure. Postexposure prophylaxis (PEP) with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatitis B surface antigen status of the source and the vaccination and vaccine-response status of the exposed person. Guidance is provided to clinicians and exposed HCP for selecting the appropriate HBV PEP. Immune globulin and antiviral agents (e.g., interferon with or without ribavirin) are not recommended for PEP of hepatitis C. For HCV postexposure management, the HCV status of the source and the exposed person should be determined, and for HCP exposed to an HCV positive source, follow-up HCV testing should be performed to determine if infection develops. Recommendations for HIV PEP include a basic 4-week regimen of two drugs (zidovudine [ZDV] and lamivudine [3TC]; 3TC and stavudine [d4T]; or didanosine [ddI] and d4T) for most HIV exposures and an expanded regimen that includes the addition of a third drug for HIV exposures that pose an increased risk for transmission. When the source person's virus is known or suspected to be resistant to one or more of the drugs considered for the PEP regimen, the selection of drugs to which the source person's virus is unlikely to be resistant is recommended. In addition, this report outlines several special circumstances (e.g., delayed exposure report, unknown source person, pregnancy in the exposed person, resistance of the source virus to antiretroviral agents, or toxicity of the PEP regimen) when consultation with local experts and/or the National Clinicians' Post-Exposure Prophylaxis Hotline ([PEPline] 1-888-448-4911) is advised. Occupational exposures should be considered urgent medical concerns to ensure timely postexposure management and administration of HBIG, hepatitis B vaccine, and/or HIV PEP.Summary -- Introduction -- Background -- Recommendations for the management of hcp potentially exposed to HBV, HCV, or HIV -- References -- Appendix A. Practice recommendations for health-care facilities implementing the U.S. Public Health Service guidelines for management of occupational exposures to bloodborne pathogens -- Appendix B. Management of occupational blood exposures.June 29, 2001.The following CDC staff members prepared this report: Elise M. Beltrami, Francisco Alvarado-Ramy, Sara E. Critchley, Adelisa L. Panlilio, Denise M. Cardo, Division of Healthcare Quality Promotion, National Center for Infectious Diseases; William A. Bower, Miriam J. Alter, Division of Viral Hepatitis, National Center for Infectious Diseases; Jonathan E. Kaplan, Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases and Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention Boris Lushniak, Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health.Includes bibliographical references (p. 33-42).11442229Infectious DiseasePrevention and ControlDiagnosisTreatment and InterventionSupersede

Guidelines for school programs to prevent skin cancer

"Skin cancer is the most common type of cancer in the United States. Since 1973, new cases of the most serious form of skin cancer, melanoma, have increased approximately 150%. During the same period, deaths from melanoma have increased approximately 44%. Approximately 65%-90% of melanomas are caused by ultraviolet (UV) radiation. More than one half of a persons lifetime UV exposure occurs during childhood and adolescence because of more opportunities and time for exposure. Exposure to UV radiation during childhood plays a role in the future development of skin cancer. Persons with a history of > or = 1 blistering sunburns during childhood or adolescence are two times as likely to develop melanoma than those who did not have such exposures. Studies indicate that protection from UV exposure during childhood and adolescence reduces the risk for skin cancer. These studies support the need to protect young persons from the sun beginning at an early age. School staff can play a major role in protecting children and adolescents from UV exposure and the future development of skin cancer by instituting policies, environmental changes, and educational programs that can reduce skin cancer risks among young persons. This report reviews scientific literature regarding the rates, trends, causes, and prevention of skin cancer and presents guidelines for schools to implement a comprehensive approach to preventing skin cancer. Based on a review of research, theory, and current practice, these guidelines were developed by CDC in collaboration with specialists in dermatology, pediatrics, public health, and education; national, federal, state, and voluntary agencies; schools; and other organizations. Recommendations are included for schools to reduce skin cancer risks through policies; creation of physical, social, and organizational environments that facilitate protection from UV rays; education of young persons; professional development of staff involvement of families; health services; and program evaluation." - p. 1Introduction -- Burden of skin cancer -- Risk factors for skin cancer -- Protective behaviors -- Concerns regarding promoting protection from UV radiation -- -- Guidelines for school programs to prevent skin cancer -- Schools as settings for skin cancer prevention efforts -- -- Skin Cancer Prevention Guidelines -- Guideline 1: Policy -- Guideline 2: Environmental change -- Guideline 3: Education -- Guideline 4: Family involvement -- Guideline 5: Professional development -- Guideline 6: Health services -- Guideline 7: Evaluation -- -- Conclusion -- References -- Appendix A. Public health action steps from the International Agency for Research on Cancer -- Appendix B . Sunscreen: how to select, apply, and use it correctly -- Appendix C. Skin cancer education resources"April 26, 2002"Prepared by: Karen Glanz, Mona Saraiya, Howell Wechsler."The material in this report was prepared for publication by the National Center for Chronic Disease Prevention and Health Promotion, James S. Marks, M.D., M.P.H., Director; the Division of Cancer Prevention and Control, Nancy C. Lee, M.D., Director; and the Division of Adolescent and School Health, Lloyd J. Kolbe, Ph.D., Director." - p. 1Cover title."U.S. Government Printing Office: 2002-733-100/69018 Region IV."--P. [4] of cover.Also available via the World Wide Web.Includes bibliographical references (p. 12-16)

National Notifiable Diseases Surveillance System: monitoring the occurrence and spread of diseases

The Centers for Disease Control and Prevention (CDC)'s National Notifiable Diseases Surveillance System (NNDSS) is a multifaceted public health disease surveillance system that allows public health officials to monitor the occurrence and spread of diseases. State, local, territorial, and tribal health departments notify CDC of cases of specific diseases and conditions that they identify in their jurisdictions. Every year, the nation's epidemiologists determine which of these diseases and conditions should be notifiable and how to define a case. Many state, territorial, tribal, and local health departments and partner organizations, such as the Council of State and Territorial Epidemiologists, use facets of NNDSS to: collect, manage, analyze, interpret, and disseminate health-related data for diseases and conditions designated as nationally notifiable; develop and maintain national standards--such as consistent case definitions for nationally notifiable diseases and conditions--that are applicable across states; maintain the official national notifiable diseases statistics; provide detailed data to CDC programs to help identify specific disease trends; work with states and partners to implement and assess prevention and control programs; and publish summarized data findings from 57 state, territorial, and local reporting jurisdictions in the Morbidity and Mortality Weekly Report (MMWR). NNDSS is administered by the Division of Notifiable Diseases and Healthcare Information in CDC's Public Health Surveillance and Informatics Program Office (proposed); Office of Surveillance, Epidemiology, and Laboratory Services.What Is the National Notifiable Diseases Surveillance System? -- Supporting state and local public health surveillance -- Connecting the healthcare system to public health -- NEDSS Base System"CS232319L.""6/5/12" - date from document propertiesAlso available via the World Wide Web as an Acrobat .pdf file (488.89 KB, 2 p.)

BioSense: public health surveillance through collaboration

The BioSense program tracks health problems in the United States as they evolve. It provides public health officials with the data, information, and tools needed to better prepare for and coordinate responses to safeguard and improve the health of Americans. The latest version, BioSense 2.0, launched in November 2011 and makes several changes to improve BioSense's ability to protect the health of the U.S. population. This collaborative data exchange system allows users to track health issues as they evolve. BioSense 2.0 is the only public health tool that provides a picture of what is happening right now with any health condition, anywhere and everywhere in the country. BioSense 2.0 pulls together information on emergency department visits and hospitalizations from multiple sources, including the Department of Veterans Affairs (VA), the Department of Defense (DoD), and civilian hospitals from around the country. The BioSense program works with state or local health departments that have agreed to share data from their own emergency department monitoring systems to collect data from civilian hospitals. Analysis of these data provides insight into the health of communities and the country. Such data are vital to guide decision making and actions by public health agencies at local, regional, and national levels. BioSense 2.0 was developed and is governed by an active collaboration of CDC, state and local health departments, and other public health partners. The BioSense program is administered by the Division of Notifiable Diseases and Healthcare Information in CDC's Public Health Surveillance and Informatics Program Office; Office of Surveillance, Epidemiology, and Laboratory Services. .What is BioSense? -- BioSense 2.0 -- Unique features of BioSense 2.0 -- BioSense data enhance situation awareness10/30/2012 - date from document propertiesCS232319KAvailable via the World Wide Web as an Acrobat .pdf file (561.73 KB, 2 p.)

Extensively Drug-Resistant Tuberculosis,Taiwan

Extensively Drug-Resistant Tuberculosis, Taiwa

Measuring elimination of podoconiosis, endemicity classifications, case definition and targets: an international Delphi exercise

BACKGROUND Podoconiosis is one of the major causes of lymphoedema in the tropics. Nonetheless, currently there are no endemicity classifications or elimination targets to monitor the effects of interventions. This study aimed at establishing case definitions and indicators that can be used to assess endemicity, elimination and clinical outcomes of podoconiosis. METHODS This paper describes the result of a Delphi technique used among 28 experts. A questionnaire outlining possible case definitions, endemicity classifications, elimination targets and clinical outcomes was developed. The questionnaire was distributed to experts working on podoconiosis and other neglected tropical diseases in two rounds. The experts rated the importance of case definitions, endemic classifications, elimination targets and the clinical outcome measures. Median and mode were used to describe the central tendency of expert responses. The coefficient of variation was used to describe the dispersals of expert responses. RESULTS Consensus on definitions and indicators for assessing endemicity, elimination and clinical outcomes of podoconiosis directed at policy makers and health workers was achieved following the two rounds of Delphi approach among the experts. CONCLUSIONS Based on the two Delphi rounds we discuss potential indicators and endemicity classification of this disabling disease, and the ongoing challenges to its elimination in countries with the highest prevalence. Consensus will help to increase effectiveness of podoconiosis elimination efforts and ensure comparability of outcome data

Clinical characteristics of children with 2009 pandemic influenza A (H1N1) admitted in a single institution

PurposeThis study aims to investigate the clinical characteristics of children diagnosed with the novel influenza A (H1N1) in the winter of 2009 at a single medical institution.MethodsOut of 545 confirmed cases of influenza A (H1N1) in children, using the real time RT-PCR method at Kosin University Gospel Hospital from September to December of 2009, 149 patients and their medical records were reviewed in terms of symptoms, laboratory findings, complications and transmission within a family.ResultsMedian age of subjects was 7 years (range: 2 months-18 years). New cases increased rapidly from September to reach a peak in November, then declined rapidly. Most frequently observed symptoms were fever (96.7%), cough (73.2%), rhinorrhea (36.9%) and sore throat (31.5%). Average body temperatures on the 1st, 2nd and 3rd hospital day were 38.75±0.65℃, 38.08±0.87℃ and 37.51±0.76℃, respectively. Complete blood counts and biochemical tests performed on the first admission day showed within the reference values in most cases. Of the 82 patients with simple chest radiography, 18 (22%) had pneumonic lesions; multi-focal bronchopneumonia in eleven, single or multi-segmental lobar pneumonia in five, and diffuse interstitial pneumonia in two patients. All of the 149 patients improved from their symptoms and discharged within 9 days of admission without any late complication.ConclusionChildren with 2009 pandemic influenza A (H1N1) at our single institution displayed nonspecific symptoms and laboratory findings, resembling those of common viral respiratory illnesses, and did not appear to develop more severe disease