Synopsis for November 21, 2003

The MMWR is embargoed until NOON ET, Thursdays.

1. Primary and Secondary Syphilis — United States, 2002
2. Health-Related Quality of Life Among Low-Income Persons Aged 45–64 Years — Behavioral Risk Factor Surveillance System, United States, 1995–2001
3. Direct and Indirect Costs of Arthritis and Other Rheumatic Conditions — United States, 1997
4. Ascertainment of Diabetes Among Young American Indians — Montana and Wyoming, 2000–2002
5. Investigation Following the Identification of a Ricin-Containing Envelope at a Postal Facility — South Carolina, 2003
6. West Nile Virus Activity — United States, November 13–19, 2003

Synopsis for November 21, 2003

Primary and Secondary Syphilis — United States, 2002

U.S. syphilis rate climbs for second consecutive year.

The rate of primary and secondary (P&S) syphilis in the United States rose 9.1 percent in 2002, representing the second consecutive year of increases in the disease, CDC reported today. P&S syphilis cases increased by 12.4 percent. The overall increase was in large part due to an increase in reported P&S cases among men, particularly gay and bisexual men. Cases among men increased 27.4 percent in 2002. Study authors estimate that 40 percent of all reported P&S syphilis cases occurred among gay and bisexual men. At the same time, cases among African Americans and women continued to decline, 19 percent and 10.3 percent respectively, pointing to the success of STD prevention efforts in some groups. Researchers note that the efforts among hardest hit populations, including African Americans and women, must be sustained even while health officials adapt to meet new challenges among gay and bisexual men.

Health-Related Quality of Life Among Low-Income Persons Aged 45–64 Years — Behavioral Risk Factor Surveillance System, United States, 1995–2001

Low-income men and women 45-64 years, especially those who are unemployed or unable to work, report substantial numbers of physically and mentally unhealthy days.

Health-related quality of life (HRQOL) of a group of older middle-aged respondents to the 1995-2001 Behavioral Risk Factor Surveillance System (BRFSS) was studied. This study found that, low-income adults aged 45-64 years report more physically and mentally unhealthy days than younger and older low-income adults as well as higher income adults of the same ages. Unemployment, inability to work, and activity limitation partially explain these HRQOL differences in this age-income group. Targeting these risk factors and improving access to health care (e.g., Medicaid, rehabilitation programs) and social services (e.g., job training programs) could help increase the quality and years of healthy life and eliminate health disparities for persons in this age group.

Direct and Indirect Costs of Arthritis and Other Rheumatic Conditions — United States, 1997

In 1997 arthritis and other rheumatic conditions (AORC) cost the United States $116.3 billion.

Total costs attributable to AORC ranged from $163 million in Wyoming to $11.3 billion in California. These estimates use better quality data on people’s health expenditures; take into account their personal characteristics and whether people had health insurance or other expensive diseases; and use conservative assumptions that probably underestimate costs. These first-ever, state-specific cost estimates for all 50 states provide a measure of the economic and societal burden of arthritis in each state. The number of persons with AORC will increase as the U.S. population ages and because of the increasing use of new and more costly interventions for AORC (e.g. COX-2 inhibitors, biological response modifiers, and total joint replacement surgery).

Ascertainment of Diabetes Among Young American Indians — Montana and Wyoming, 2000–2002

Recent studies suggest that type 2 diabetes is increasing among American Indian youth.

Determining methods to accurately identify cases of diabetes among American Indian youth is important in establishing the number of youth with diabetes and in monitoring their growing numbers. This study assessed methods of using the patient database of the Indian Health Service to identify youth with diabetes in Montana and Wyoming, and found that using two patient visits for diabetes in a three-year period was more accurate in identifying diabetes cases than using one patient visit only. Health care systems and managed care organizations that use patient databases for diabetes surveillance should 1) evaluate the ability of patient databases to accurately identify diabetes in young persons, and 2) update and maintain case registries based on patient databases.

Investigation Following the Identification of a Ricin-Containing Envelope at a Postal Facility — South Carolina, 2003

Ricin is a biologic toxin derived from the pulp and meal of the castor bean. Several instances of ricin procurement for use as a terrorist or criminal weapon have been documented.

On October 15, 2003, an envelope with a threatening note and a sealed container was processed at a mail processing and distribution facility in Greenville, South Carolina. Laboratory testing at CDC confirmed that the substance in the container was ricin. The facility was closed, and CDC conducted environmental assessment and sampling. No employees had illness suggestive of ricin exposure. Routes of exposure to ricin include ingestion, inhalation, parenteral (injection), dermal, or ocular. Because ricin poisoning might resemble a typical gastroenteritis-type or respiratory illness, it might at first be difficult to discern from other illness. For this reason, cases should be deemed as suspicious for ricin poisoning in conjunction with epidemiologic clues suggestive of chemical release or a credible threat of chemical release in a community.

West Nile Virus Activity — United States,
November 13–19, 2003

No summary available.

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