Synopsis for November 14, 2003

The MMWR is embargoed until NOON ET, Thursdays.

1. Cholera Epidemic After Increased Civil Conflict — Monrovia, Liberia, June–September 2003
2. Tobacco Use Among Middle and High School Students — United States, 2002
3. History of Foot Ulcer Among Persons with Diabetes — United States, 2000–2002
4. First Human Death Associated with Raccoon Rabies — Virginia, 2003
5. Outbreak of Severe Rotavirus Gastroenteritis Among Children — Jamaica, 2003
6. West Nile Virus Activity — United States, November 6–12, 2003

Synopsis for November 14, 2003

Cholera Epidemic After Increased Civil Conflict — Monrovia, Liberia, June–September 2003

Cholera is often a danger in humanitarian emergencies because normal mechanisms of water supply and sanitation are disrupted by fighting and population displacement.

Following recent fighting and population displacement, Monrovia, Liberia has experienced one of the largest cholera outbreaks in its recent history. Although international organizations, U.N. agencies, and the Liberian Ministry of Health have been preventing many deaths by providing adequate treatment for cholera patients, few effective prevention measures have been implemented so far. These will be necessary to stop the outbreak by preventing transmission of cholera bacteria.

Tobacco Use Among Middle and High School Students — United States, 2002

Because tobacco use is the leading cause of preventable death in the United States, efforts to reduce tobacco use must remain a public health priority.

Each day in the United States, approximately 4,400 youths aged 12–17 years try their first cigarette. An estimated one third of these young smokers are expected to die from a smoking-related disease. The National Youth Tobacco Survey (NYTS), conducted by the American Legacy Foundation, provides estimates of usage among U.S. middle and high school students for a variety of tobacco products (e.g., cigarettes, cigars, smokeless, tobacco, pipes, bidis [flavored cigarettes], and kreteks [clove cigarettes]). This report summarizes tobacco use estimates from the 2002 NYTS and describes changes since 2000. Cigarette, cigar, bidi, and kretek smoking and tobacco use overall decreased from 2000 to 2002 among students in high school (i.e., grades 9–12); however, there was no significant decline in overall tobacco use or for use of any individual tobacco product among students in middle school (i.e., grades 6–8).

History of Foot Ulcer Among Persons with Diabetes — United States, 2000–2002

All people with diabetes should receive annual foot examinations to identify high-risk foot conditions, such as loss of feeling, deformities, or sores that do not heal.

Nearly 12% of Americans with diabetes have a history of a foot ulcer which places them at high risk of further ulceration or lower extremity amputation (LEA). Over 60% of all LEAs in the U.S. occur among people with diabetes, and about 85% of these LEAs are preceded by a foot ulcer. People with diabetes may benefit from annual foot examinations to prevent or delay the development of foot ulcers and LEAs. Although the rate of annual foot examinations among people with diabetes increased from 1995 to 2001, it is still below the national target of 75%.

First Human Death Associated with Raccoon Rabies — Virginia, 2003

Human rabies is a rare, but fatal, disease in the United States.

On March 10, 2003, a previously healthy man aged 25 years who resided and worked in northern Virginia died with a diagnosis of meningoencephalitis of unknown etiology after a 3-week illness. Testing of tissue samples at CDC revealed viral inclusions suggestive of Negri bodies, and subsequent tests confirmed a diagnosis of rabies. Genetic sequencing identified a rabies virus variant associated with raccoons, but how the patient acquired infection remains unknown. This report summarizes the investigation of the first documented case of a human death from raccoon rabies in the United States. Human rabies can be prevented by avoiding exposure to suspicious animals, vaccinating and supervising pets, and seeking prompt medical attention if a bite occurs.

Outbreak of Severe Rotavirus Gastroenteritis Among Children — Jamaica, 2003

Worldwide, rotavirus remains a major cause of severe diarrheal illness and death, which could be prevented by oral rehydration therapy.

Rotavirus was found to be the cause of a large, unusual outbreak of severe acute gastroenteritis in Jamaica that led to several deaths. This outbreak serves as a reminder that rotavirus remains a major cause of diarrheal disease in children worldwide, and emphasizes the importance of surveillance for rotavirus illness. Every minute a child dies from rotavirus disease somewhere in the world. Effective vaccines are needed and are currently under development. This outbreak also highlights the value of oral rehydration therapy in preventing severe disease and death once a child or adult has a diarrheal illness.

West Nile Virus Activity — United States, November 6–12, 2003

No summary available.

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