Synopsis for March 26, 2004

The MMWR is embargoed until Thursday, 12 PM EST.

1. Unintentional and Undetermined Poisoning Deaths ― 11 States, 1990-2001
2. Progress Toward Poliomyelitis Eradication ― India, 2003
3. Osteomyelitis/Septic Arthritis Caused by Kingella kingae Among Day Care Attendees — Minnesota, 2003
4. Kingella kingae Infections in Children ― United States, June 2001-November 2002

Synopsis for March 26, 2004

Unintentional and Undetermined Poisoning Deaths ― 11 States, 1990-2001

Eleven state health departments reported a dramatic range in rates and trends for unintentional and undetermined poisonings between 1990 and 2001. Because each state presented a different poisoning mortality profile, developing effective interventions will require the use of local poisoning surveillance data and knowledge of the factors that contribute to drug misuse, addiction and the changing patterns of misused drugs, medication and alcohol.

The poisoning death rate in the United States increased 56% between 1990 and 2001; the majority of these deaths (63%) were unintentional. In response to this national increase, eleven state health departments implemented the first collaborative examination of state-level poisoning data. These states analyzed vital statistics data from 1990-2001 and reported that unintentional and undetermined poisoning deaths increased an average of 145%, ranging from a 28% increase to a 325% increase. The increase was highest among individuals between the ages of 35 to 54, with women (203%) experiencing a greater increase than men (126%). Data from eight of the states indicated that narcotics and psychodysleptics, which include opioids and cocaine, were associated with more than one-half of the poisoning deaths in 1999 and 2000. To develop effective intervention plans to reduce deaths from drug overdoses, state health departments should continuously monitor their own experiences from local surveillance data, in addition to national data on poisoning deaths.

Progress Toward Poliomyelitis Eradication ― India, 2003

India has taken action to reduce poliovirus transmission.

Since the World Health Assembly resolved in May 1988 to eradicate poliomyelitis, the estimated global incidence of polio has decreased by more than 99%, and three World Health Organization (WHO) regions (American, Western Pacific, and European) have been certified as polio-free. The countries of the WHO South East Asia Region began accelerating polio eradication activities in 1994, and have made substantial progress toward that goal. By 2001, poliovirus circulation in India had largely been limited to the two northern states of Uttar Pradesh (UP) and Bihar; 268 cases were reported nationwide. However, a major resurgence of polio occurred during 2002, with 1,600 cases detected nationwide, or which 1363 (85%) occurred in these two states.

Osteomyelitis/Septic Arthritis Caused by Kingella kingae Among Day Care Attendees — Minnesota, 2003

Clinicians and laboratorians must consider K. kingae in young children with bone/joint infections so that proper laboratory procedures can be done.

Kingella kingae is a bacterium that children sometimes carry in their throats that rarely causes serious infections. In October 2003, the Minnesota Department of Health investigated two culture-confirmed and one probable case of bone/joint infections caused by K. kingae. The three children were in the same toddler classroom in a day care center and presented in the same week. Investigation found that many children in the same class carried the bacterium without being ill. No previous outbreaks of K. kingae have been reported. Cases of K. kingae infection are frequently missed because special laboratory procedures (keeping culture plates longer and using a different culture system) are required to uncover it. Clinicians and laboratorians need to be aware of these special procedures in order to do appropriate laboratory testing.

Kingella kingae Infections in Children ― United States, June 2001-November 2002

Kingella infections may be underdiagnosed in the U.S. and clinicians can improve detection of Kingella through increased use of blood culture bottles when diagnosing bone and joint infections.

Kingella kingae is a bacteria that increasingly has been recognized as a cause of infections in the bones and joints of children. Diagnosing Kingella and other bacteria in bone and joint infections is difficult since many doctors do not attempt to draw fluid from joints and Kingella does not grow well when cultured using routine methods. Recent studies have shown that Kingella can be identified more frequently when doctors place joint fluid into blood culture bottles. This MMWR reports findings of a survey of infectious diseases doctors which revealed that 35% of respondents did not use blood culture bottles when diagnosing bone and joint infections. In addition, respondents reported 18 cases of Kingella infections, the largest reported in the US. This survey suggests that Kingella infections may be underdiagnosed in the U.S. and that clinicians can improve detection of Kingella through increased use of blood culture bottles when diagnosing bone and joint infections.

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