Public Health Reports®

Ciguatera fish poisoning is a potentially life-threatening disease caused by eating coral reef fish contaminated with ciguatoxins and is the most common marine poisoning. However, existing surveillance systems capture few cases. To improve regional ciguatera surveillance in South Florida, this study compared ciguatera illnesses in the Florida Poison Information Center–Miami (FPICM) call database to ciguatera cases in the Florida Department of Health (FDOH) disease surveillance systems.

Univariate and multivariate logistic regression were used to identify predictors of when FPICM reported ciguatera illnesses to FDOH and whether FDOH confirmed reported ciguatera cases.

FPICM staff preferentially reported ciguatera illnesses that were of shorter duration (adjusted odds ratio [AOR]=0.84 per additional illness day; 95% confidence interval [CI] 0.74, 0.97); outbreak-associated (AOR=7.0; 95% CI 2.5, 19.5); and clinically more severe (AOR=21.6; 95% CI 2.3, 198.5). Among ciguatera illnesses reported to FDOH, outbreak-associated illnesses were more likely than single, sporadic illnesses to become confirmed surveillance cases (crude OR=11.1; 95% CI 2.0, 62.5).

The over-representation of outbreak-associated ciguatera cases underestimates the true contribution of sporadic illnesses to ciguatera disease burden. This bias should be considered when evaluating surveillance systems that include both outbreak-associated and sporadic illness reports.

The purpose of this ecological study was to relate West Nile virus (WNV) human case fatality rates to county-level demographic and surveillance variables, thereby characterizing the populations to which WNV poses the greatest threat.

The authors acquired data on human, avian, and mosquito WNV infections for the 13 states in which there were 100 or more human cases during 2003. The data on avian and mosquito infections were converted into surveillance variables using empirical Bayes methodology. A preliminary logistic regression model was formulated to relate these surveillance variables and demographic variables to case fatality rates. The statistical technique of backward elimination was applied to obtain a final model in terms of the variables most useful for predicting case outcomes.

The probability of a fatal outcome depends on the poverty rate for the county in which the infected person lives (p=0.0283), the average temperature (p<0.0001), and surveillance variables reflecting the fractions of Culex pipiens and Culex restuans mosquitoes among infected mosquitoes (p=0.0079; p=0.0076).

Effective WNV educational programs and control measures are vital, especially in poverty-stricken areas. A uniform protocol for disseminating county-level data could facilitate timely responses to WNV outbreaks and to emerging infectious diseases more generally.

American Indians and Alaska Natives (AI/AN) adults ≥65 years of age (older adults) have the second highest age group-specific infectious disease (ID) hospitalization rate. To assess morbidity and disparities of IDs for older AI/AN adults, this study examined the epidemiology of overall and specific infectious disease hospitalizations among older AI/AN adults.

ID hospitalization data for older AI/AN adults were analyzed by using Indian Health Service hospital discharge data for 1990 through 2002 and comparing it with published findings for the general U.S. population of older adults.

ID hospitalizations accounted for 23% of all hospitalizations among older AI/AN adults. The average annual ID hospitalization rate increased 5% for 1990–1992 to 2000–2002; however, the rate increased more than 20% in the Alaska and the Southwest regions. The rate for older AI/AN adults living in the Southwest region was greater than that for the older U.S. adult population. For 2000–2002, lower respiratory tract infections accounted for almost half of all ID hospitalizations followed by kidney, urinary tract, and bladder infections, and cellulitis.

The ID hospitalization rate increased among older AI/AN adults living in the Southwest and Alaska regions, and the rate for the older AI/AN adults living in the Southwest region was higher than that for the U.S. general population. Prevention measures should focus on ways to reduce ID hospitalizations among older AI/AN adults, particularly those living in the Southwest and Alaska regions.

The purpose of this study was to determine from state and local health departments: (1) how they purchase, distribute, and fund influenza vaccine; (2) whether they experienced a shortage in 2003/04; (3) how the shortages were handled; and (4) how they prepared for distribution in 2004/05.

A web-based survey was completed from June to August 2004 in eight Southeastern states.

Data were obtained from each state and 222 local health departments. Major differences between and within states were found with regard to purchasing, distributing, and funding influenza vaccine. Although the majority of health departments experienced periods of shortages in 2003/2004, surpluses of vaccine remained at the end of the season. There was little evidence of interaction between the public and private sectors to share vaccine resources in response to shortages. Tracking systems for redistribution of vaccine or follow-up were often not in place. Entering the 2004/05 season, 25% of states and 11% of counties were not developing any special procedures to deal with shortages beyond what was in place earlier.

Better systems and funding are needed, especially for adult influenza vaccine delivery and for redistribution of influenza vaccine in response to shortages.

In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of mother-to-child transmission (PMTCT) program data for HIV surveillance was evaluated.

UAT and PMTCT data were compared at the same clinics and for the same time (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as the number of ANC attendees tested for HIV out of those who had their first ANC visit during the ANC surveillance period. Odds ratios and 95% confidence intervals were calculated to determine associations between demographic characteristics and HIV testing acceptance.

Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across several logbooks with varying quality. For PMTCT, 2,239 women were offered HIV testing and 1,258 (56%) accepted; for UAT, 1,852 women were sampled. Median UAT-based HIV prevalence was 12.8% (range, 8.1%–26.3%) compared with 14.4% (range, 7.0%–27.2%) in PMTCT. HIV testing acceptance for PMTCT ranged from 48% to 69% across clinics, and was more likely among primigravidae than multigravidae.

Because of varying PMTCT data quality and varying HIV testing acceptance for PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-based estimates in Kenya.

Despite the existence of mandatory reporting laws, the underreporting of disease conditions to public health authorities is widespread. This article describes an evaluation of the effects of using different appeals to promote complete and timely reporting to the New York State Occupational Lung Disease Registry (NYS OLDR).

Three-hundred sixty-eight physicians who had not reported patients were randomly assigned to receive correspondence emphasizing either the legal obligation to report, the public health benefits of reporting, or both. Chi-square tests were used to determine if the proportion of physicians who subsequently reported patients differed by message group. Chi-square tests and the Kruskall Wallis rank sum test were used to test for differences in the completeness and timeliness of reports received from physicians in the three message groups.

Physicians receiving correspondence describing the legal obligation to report were more likely to report patients than those receiving only the benefit message, while those receiving correspondence describing the public health benefits of reporting submitted more complete reports than those receiving only the obligation message.

To maximize physician reporting, it is important for public health agencies to emphasize both the legal and public health basis for reporting conditions in correspondence to physicians.

This study was conducted to assess the accuracy of self-reported hepatitis C virus (HCV) antibody (anti-HCV) serostatus in injection drug users (IDUs), and examine whether self-reported anti-HCV serostatus was associated with recent injection risk behavior.

In five U.S. cities (Baltimore, Chicago, Los Angeles, New York, and Seattle), 3,004 IDUs from 15 to 30 years old were recruited for a baseline interview to determine eligibility for a randomized controlled trial of a behavioral intervention. HIV and HCV antibody testing were performed, and subject data (e.g., demographics, drug and sexual risk behavior, and history of HIV and HCV testing) were collected via audio computer-administered self-interview. Risk behavior during the previous three months was compared to self-reported anti-HCV serostatus.

Anti-HCV prevalence in this sample of young IDUs was 34.1%. Seventy-two percent of anti-HCV-positive and 46% of anti-HCV-negative IDUs in this sample were not aware of their HCV serostatus. Drug treatment or needle exchange use was associated with increased awareness of HCV serostatus. Anti-HCV-negative IDUs who knew their serostatus were less likely than those unaware of their status to inject with a syringe used by another IDU or to share cottons to filter drug solutions. Knowledge of one's positive anti-HCV status was not associated with safer injection practices.

Few anti-HCV-positive IDUs in this study were aware of their serostatus. Expanded availability of HCV screening with high quality counseling is clearly needed for this population to promote the health of chronically HCV-infected IDUs and to decrease risk among injectors susceptible to acquiring or transmitting HCV.

This study's objective is to determine if there is an association between rates of violence and rates of childhood asthma in Los Angeles County communities.

Rates of hospitalization for assault and for asthma were calculated for each ZIP Code and city in Los Angeles County. Linear regression was used to determine the effect of assault rates on asthma rates while controlling for potential confounders such as poverty and racial/ethnic distribution. At the city level, crime rates were included in the model as additional measures of community violence.

Hospitalization rates for childhood asthma and assaults were significantly correlated at both the city (r=0.80) and the ZIP Code (r=0.54) levels. The association remained significant when controlling for poverty and racial/ethnic distribution with linear regression (p<0.0001). At the city level, the variables measuring the crime rate were not significant predictors of asthma hospitalizations.

Community violence as measured by the rate of assault hospitalizations is associated with childhood asthma in Los Angeles County. Health care providers should consider their asthmatic patients' social environments when devising treatment plans.

This study was conducted to determine whether children born to mothers receiving inadequate prenatal care are at an increased risk for having an elevated blood lead level during early childhood.

The authors conducted a population-based study of children born in Providence, Rhode Island, from 1997 to 2001 whose mothers had received adequate, intermediate, or inadequate prenatal care. The children's blood lead levels were compared between groups using bivariate and logistic regression. To understand the regulatory implications and public health impact of changing the definition of an elevated blood lead level, “elevated” was defined as 5 μg/dL, 10 μg/dL, and 15 μg/dL.

Children born to mothers who received inadequate prenatal care were at an elevated risk for having an elevated blood lead level later in life. This relationship remained statistically significant for each definition of elevated blood lead level and after controlling for other socio-economic status measures and birthweight (at 5 μg/dL, odds ratio [OR]=1.36, 95% confidence interval [CI] 1.09, 1.68, p=0.006; at 10 μg/dL, OR=1.68, 95%CI 1.26, 2.24, p<0.0004; at 15 μg/dL, OR=1.83, 95% CI 1.10, 3.04, p=0.019) represent an opportune moment to identify expectant mothers living in lead-contaminated environments.

Results suggest that conducting lead screening as a regular part of prenatal care provision could help identify women possibly experiencing ongoing lead exposure and help reduce or prevent exposures to their offspring.

Given the national effort to respond to the challenge of terrorism post-9/11, this study examined the organizational structure of state public health preparedness programs across the country, their administration, and the personnel and resources supported through federal cooperative agreements and state funds.

In Fall 2004, the Association of State and Territorial Health Officials surveyed state public health preparedness directors of all 50 states and territories of the United States regarding the organizational structure, administration, personnel, and resources of the state public health preparedness programs.

Individuals representing 45 states and the District of Columbia responded to the web-based questionnaire for a response rate of 88.2%. States tended to subdivide their organizations into regions for preparedness purposes. More than half the established preparedness regions (53.8%) were created post-9/11. Preparedness program directors frequently reported directly to either the state health official (40.0%) or a deputy state health official (33.3%). Responsibility for both the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) cooperative agreements was predominantly vested in one person (73.3%). Federal resources were found to support needed preparedness workforce (CDC mean=117.1 full-time equivalents [FTEs]; HRSA mean=10.6 FTEs). In addition, 36.6% of the states also contributed to the public health preparedness budget.

This study of state public health agency preparedness provides new information about state-level organizational structure, administration, and support of preparedness programs. It offers the first comprehensive insights into the approaches states have adopted to build infrastructure and develop capacity through CDC and HRSA funding streams.

Men have higher mortality rates than women for most causes of death. This study was conducted to determine the contribution of specific causes of death to the sex difference in years of potential life lost (YPLL).

The authors examined data from the National Health Interview Survey with linked mortality data through 1997. Using survival analysis estimates, a stochastic simulation model to simulate death events for cohorts of white, African American, and Latino adults was created.

YPLL from all causes were greater among men than women. Homicide, motor vehicle accidents, and suicide accounted for 33% of YPLL sex difference among whites, 36% among African Americans, and 52% among Latinos. For all three racial/ethnic groups, cardiovascular disease (principally ischemic heart disease) was the second largest contributor to the sex difference in YPLL (29% among whites, 23% among African Americans, and 25% among Latinos). Lung cancer was also important among whites and African Americans, accounting for 15% and 17% of the sex difference in YPLL from all causes, respectively.

Ischemic heart disease, lung cancer, and traumatic deaths account for as much as three-quarters of the excess YPLL among men, suggesting that a few modifiable behaviors such as the use of tobacco, alcohol, and drugs and violence may account for much of the shorter life expectancy among men.

National studies suggest that the prevalence of current smoking among Asian Americans is lower than that for other racial/ethnic groups. However, these studies may have yielded inaccurate estimates because of the underrepresentation of non-English-speaking groups. Using data from the National Latino and Asian American Study (NLAAS), the authors estimated the prevalence of current and lifetime smoking among Asian Americans.

Current and lifetime smoking status was assessed through a population-based survey administered to Asian American adults aged 18 and older.

An overall current smoking prevalence of 14.9% was found, with notable differences by gender, nativity, and other sociodemographic factors. The prevalence of current smoking was higher among foreign-born vs. U.S.-born men (24.9% vs. 15.6%), while U.S.-born women had a higher prevalence than foreign-born women (6.3% vs. 11.7%). Overall, 28.3% of Asian Americans were ever smokers (including current and former smokers), suggesting that approximately half of ever smokers cease smoking. Results indicated that some Asian American groups are more likely to initiate smoking and/or be more likely to continue smoking.

Results revealed that the prevalence of current smoking exceeds that of the general U.S. population for some Asian American groups and suggest that excluding non-English-speaking Asian Americans may underestimate the prevalence of smoking among men. Findings indicate that some Asian American groups are at greater risk for initiating smoking and/or continuing smoking, and highlight the need for tailored interventions that address differential smoking patterns by gender, nativity, and other social characteristics.