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MMWR – Morbidity and Mortality Weekly Report

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1. Trends in Tuberculosis — United States, 2013

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Data indicate that cases and rates of TB disease continue to fall in the U.S.; however, a higher burden in some populations – such as foreign-born individuals and racial/ethnic minorities – keeps TB elimination out of reach. Preliminary data from the CDC National TB Surveillance System show a total of 9,588 cases were reported in the U.S. in 2013, marking a 4.2 percent decline in the 2012 rate (from 3.2 to 3.0 cases per 100,000 population). Despite overall progress, the TB rate for foreign-born individuals is 13 times higher than among individuals born in the U.S., and the proportion of TB cases in the foreign-born group continues to increase. Racial disparities persist. Hispanics, blacks and Asians face higher TB rates—7, 7 and 26 times higher, respectively—than whites. Persons infected with HIV and people who are homeless are also especially vulnerable to TB. Although the proportion of drug-resistant cases remains relatively small, drug resistant TB is a concern because it is difficult and costly to treat and more often fatal. In 2012, multidrug-resistant TB accounted for 1.2 percent of cases (86 cases). Two cases of extensively-drug-resistant TB were reported in 2013. The authors note that eliminating TB in the U.S. requires continuing to address TB in affected populations and improvements in awareness, testing and treatment of TB disease.

2. Implementation of New TB Screening Requirements for U.S.-Bound Immigrants and Refugees — 2007–2014

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Updated CDC recommendations for overseas tuberculosis screening of immigrants and refugees has resulted in better diagnosis of TB before individuals arrive in the United States. CDC reports the completion of implementation of new tuberculosis screening and treatment requirements for US-bound immigrants and refugees. Implementation of these requirements has resulted in twice as many cases of tuberculosis being diagnosed and treated before immigrants and refugees arrive in the U.S. compared with the previous screening program. Since the new requirements were implemented, reports of cases of foreign-born tuberculosis have declined. In addition, the increase in persons diagnosed and treated overseas is projected to result in a savings of more than $15 million in US health care costs. 

3. Combined Use of Inactivated and Oral Poliovirus Vaccines in Refugee Camps and Surrounding Communities — Kenya, December 2013

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Experience in Kenya has shown that combined inactivated and oral poliovirus vaccine campaigns can achieve high coverage and could be a useful tool to promptly stop the spread of poliovirus in certain polio outbreaks and in endemic areas. Globally, only three countries have never interrupted circulation of wild poliovirus: Afghanistan, Nigeria, and Pakistan. The Global Polio Eradication Initiative conducts campaigns using oral polio vaccine (OPV) to increase population immunity. In certain settings, administering inactivated poliovirus vaccine (IPV) with OPV through mass campaigns could more quickly raise community protection and stop the spread of poliovirus. Kenya recently conducted the first-ever campaign providing OPV in combination with IPV. The experience proved that although these campaigns cost more, they are feasible and can reach more than 90 percent of at-risk children. Careful planning can help overcome the complexities of this kind of two-vaccine campaign.

4. Update on Vaccine-Derived Polioviruses — Update on Vaccine-Derived Polioviruses — Worldwide, July 2012–December 2013

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Polio eradication means the end of circulation of all poliovirus, including vaccine-derived poliovirus and immunodeficiency-associated vaccine-derived poliovirus. Circulating vaccine-derived polioviruses (cVDPVs) are biologically equivalent to wild polioviruses, emerge when populations have low type-specific immunity, and can circulate indefinitely. Immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) will continue to emerge as long as oral polio vaccine (OPV) is used. The WHO strategic plan to shift from trivalent OPV to bivalent OPV by 2016 will include introduction of at least one routine dose of inactivated polio vaccine (IPV) worldwide, setting the stage for a subsequent worldwide shift from OPV to IPV. VDPVs, recognized by their high genetic divergence from the oral poliovaccine (OPV) strains, fall into three categories: 1) cVDPVs from outbreaks, 2) iVDPVs from patients with primary immunodeficiencies, and 3) ambiguous VDPVs (aVDPVs) that cannot be definitively identified. During July 2012-December 2013, new cVDPV outbreaks were identified in Pakistan and Chad with spread to neighboring countries; outbreaks in Afghanistan and Somalia continued; and a large outbreak in Nigeria had nearly stopped. Ten newly identified persons in eight countries were found to excrete iVDPVs. Because more than 85 percent of VDPVs are type 2, WHO plans coordinated worldwide replacement of trivalent OPV with bivalent OPV (types 1 and 3), preceded by introduction of at least one dose of IPV, by 2016.

4. Notes from the Field

  • A Cluster of Lymphocytic Choriomeningitis Virus Infections Transmitted through Organ Transplantation — Iowa, 2013

 

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