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MMWR – Morbidity and Mortality Weekly Report

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1. Tobacco Product Use Among Middle and High School Students — United States, 2011 and 2012

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During 2011-2012 there was no significant decline in cigarette smoking or overall tobacco use among U.S. middle and high school students while there were significant increases in the use of emerging tobacco products, notably electronic cigarettes, hookahs (or water pipes), and cigars. Data from the 2012 National Youth Tobacco Survey (NYTS) show that recent electronic cigarette use rose among middle school students from 0.6 percent in 2011 to 1.1 percent in 2012, and among high school students from 1.5 percent to 2.8 percent. Hookah (or water pipe) use among high school students rose from 4.1 percent to 5.4 percent from 2011 to 2012. During 2011-2012, cigar use increased dramatically among non-Hispanic black high school students from 11.7 percent to 16.7 percent, and has more than doubled since 2009. In 2012, cigar use among high school males was 16.7 percent, similar to cigarette use among high school males (16.3 percent). Electronic cigarettes, hookahs, cigars and other new types of tobacco products are not currently subject to FDA regulation.

2. Use of Japanese Encephalitis Vaccine in Children: Recommendations of the Advisory Committee on Immunization Practices

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Japanese encephalitis vaccine is recommended for adults and children ≥2 months of age at increased risk of Japanese encephalitis during travel to Asia. Japanese encephalitis (JE) virus is spread by mosquitoes and causes severe disease in Asia.  Although no treatment is available, the disease is vaccine-preventable.  The risk for JE for most travelers is very low, but varies based on travel destination, duration, season, and activities.  JE vaccine is recommended for some travelers to Asia who will be in a higher-risk setting.  Inactivated Vero cell culture-derived JE vaccine (Ixiaro) is the only JE vaccine licensed and available in the United States. In 2009, Ixiaro was licensed and recommended for use in adults at increased risk of JE during travel to Asia. In June 2013, the CDC Advisory Committee on Immunization Practices (ACIP) extended the recommendations for use of Ixiaro to include children ≥2 months of age.

3. Notes from the Field:

  1. Late Vitamin K Deficiency Bleeding in Infants Whose Parents Declined Vitamin K Prophylaxis — Tennessee, 2013

    A Vitamin K injection is recommended for all children at birth because it prevents late vitamin K deficient bleeding (VKDB), a rare but serious bleeding disorder that can occur in infants 2 weeks to 6 months of age if the injection is not received. Bleeding in the brain from vitamin K deficiency may lead to neurological abnormalities, and it can even be fatal. CDC has identified a cluster of newborns with late vitamin K deficient bleeding (VKDB), a rare, serious, but preventable bleeding disorder that can cause bleeding in the brain. In each case, the newborn’s parents declined vitamin K injection at birth. The late form of VKDB develops in infants two to 6 months of age who do not have enough vitamin K dependent proteins in their bodies to produce blood clots.   Ensuring that every newborn receives a Vitamin K injection at birth is the best way to prevent this disorder. While administering vitamin K injections at birth is standard practice in the United States, and has been recommended by the American Academy of Pediatrics since 1961, some parents are opting out of the injection. Bleeding in the brain from vitamin K deficiency may lead to neurological abnormalities, and it can even be fatal.

  2. Primary Amebic Meningoencephalitis Associated with Ritual Nasal Rinsing — St. Thomas, U.S. Virgin Islands, 2012
  3. Outbreak of Tuberculosis Caused by a Newly Identified Mycobacterium tuberculosis Genotype — New York City, 2010–2013

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