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MMWR – Morbidity and Mortality Weekly Report

1. Measles Outbreak Associated with an Arriving Refugee — Los Angeles County, California, August–September 2011

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Measles should be suspected in any patient with a fever and a rash who has recently traveled internationally. In August-September 2011, the Los Angeles County Department of Public Health (LACDPH) and California Department of Public Health (CDPH) investigated a measles outbreak associated with an ill unvaccinated refugee traveling from Malaysia to Los Angeles for resettlement in the United States. Health officials identified 3 other measles cases in Los Angeles County among persons who had been exposed to the index patient: 2 unvaccinated infants on the same flight and 1 adult customs worker who did not have proof of measles vaccination. A total of 298 people were interviewed in this large outbreak response. This outbreak emphasizes the importance of ongoing vigilance for measles in the United States, particularly among incoming international travelers, and the importance of vaccinating persons at increased risk of measles exposure.

2. CDC Grand Rounds: Newborn Screening and Improved Outcomes

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States that invest in effective tobacco control programs at levels recommended by CDC can achieve larger and more rapid reductions in tobacco use and tobacco-related deaths, disease, and health care costs. While the intent of the 1998 Master Settlement Agreement was to reimburse states for Medicaid costs related to tobacco use and to prevent youth initiation of smoking, states have used the monies to pay general expenses or to fund programs other than tobacco control. From 1998 to 2010, states collected a combined total of $243.8 billion in tobacco industry settlement pay­ments and cigarette excise tax revenues, but invested only $8.1 billion in effective state tobacco control programs.  Had states followed CDC’s published Best Practices guidelines, they would have invested $29.2 billion during that period. While total state and federal investment in state tobacco control efforts increased from 1998 to 2002, state investments have declined steadily every year since. And, currently, many states face substantial cuts and near-elimination of program funding.

3. Licensure of 13-Valent Pneumococcal Conjugate Vaccine for Adults Aged 50 Years and Older

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On December 30, 2011, FDA approved 13-valent pneumococcal conjugate vaccine (PCV13) for prevention of pneumonia and invasive disease among adults 50 years and older. The ACIP Pneumococcal Vaccines Work Group reviewed the results of immunogenicity and safety studies conducted to obtain FDA approval and identified two critical gaps in evidence needed to support a recommendation for routine PCV13 use among adults: 1) results from an ongoing clinical trial of PCV13 efficacy against pneumococcal pneumonia, and 2) data that will tell us if use of PCV13 in children also prevents adult disease. At this time, two vaccines for prevention of pneumococcal disease are licensed for adults: 23-valent pneumococcal polysaccharide vaccine (PPSV23) and PCV13. ACIP recommendations for PPSV23 use remain unchanged. PCV13, although not yet recommended by ACIP, is available for use in accordance with the package insert. Physicians can use the vaccine for adults 50 years of age and older consistent with the package insert.

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