Synopsis for January 21, 2000

MMWR articles are embargoed until 4 p.m. Eastern time on Thursday.

1. Guidelines for Surveillance, Prevention, and Control of West Nile Virus Infection — United States
2. Accutane® –Exposed Pregnancies — California, 1999
3. Update: Raccoon Rabies Epizootic — United States and Canada, 1999
4. Recommended Childhood Immunization Schedule — United States, 2000

Synopsis for January 21, 2000

Guidelines for Surveillance, Prevention, and Control of West Nile Virus Infection — United States

The 1999 West Nile virus outbreak in New York City resulted in 61 human cases; including 7 deaths.

 

PRESS CONTACT: Division of Media Relations CDC, Office of Communication (404) 639–3286

On November 8-9, 1999, CDC and the U.S. Department of Agriculture co-sponsored a meeting to the review last year's West Nile virus outbreak. The outbreak raised the issue of preparedness of public health agencies to cope with sporadic and outbreak-associated vector-borne diseases. Some of the guidelines established as a result of the meeting include: enhanced surveillance of bird migration patterns, laboratory capacity to identify arbovirus infections, and prevention and control of mosquito populations. Recent federal funding to state and local health departments will enable these agencies to increase surveillance activities, and enhance laboratory capacity for identifying such viruses. These activities are particularly needed in areas already affected or having a potential for being affected by West Nile virus; including areas from Massachusetts to Texas along the Atlantic and Gulf coasts.

Accutane® –Exposed Pregnancies — California, 1999

Accutane®-exposed pregnancies continue to occur and result in major birth defects.

 

PRESS CONTACT: Margaret (Peggy) Honein, Ph.D., M.P.H. CDC, National Center for Environmental Health (770) 488–7160

Accutane® is a prescription drug licensed for the treatment of severe acne that has not responded to other treatments. However, the drug causes severe birth defects if taken during pregnancy. Despite package warnings and a pregnancy prevention program, Accutane®-exposed pregnancies continue to occur. In this study of 14 women with recent Accutane®-exposed pregnancies, some of the reasons for exposure included: using Accutane® unnecessarily, not using any contraception or not using two effective methods of contraception as recommended during Accutane® treatment, not waiting until three days after menstruation to begin Accutane®, not performing pregnancy tests prior to prescribing Accutane®, prescribing outside the usual doctor-patient relationship, and use of leftover medication. Physicians should use caution in prescribing Accutane® to women of childbearing potential.

Update: Raccoon Rabies Epizootic — United States and Canada, 1999

The raccoon variant of rabies has spread throughout the east coast of the United States, and is now spreading north into Canada and westward into the Ohio River Valley.

 

PRESS CONTACT: Candace McCall, D.V.M., M.P.H. CDC, National Center for Infectious Diseases (404) 639–2375

Raccoons have accounted for the largest percentage of animal rabies reported to the CDC since 1990, and 99% of these cases are reported from the east coast. A distinct variant of raccoon rabies virus was first introduced to the Virginia/West Virginia area in 1977, and this variant has now spread throughout the east coast and into Canada. Although physical barriers like mountains and rivers have slowed the spread of the raccoon variant of rabies, infected raccoons have managed to cross these barriers into the Ohio River Valley and Canada. If this variant of rabies becomes established in the Ohio River Valley, there will be few geographic barriers to stop its spread throughout the mid-western United States. Oral rabies vaccine and trap/vaccinate/release programs have been initiated to control the spread of rabies in several U.S. states and some parts of Canada; however, this method of control is generally unproven in areas where rabies is already established.

Recommended Childhood Immunization Schedule — United States, 2000

Several changes highlight the childhood immunization schedule for 2000.

 

PRESS CONTACT: Division of Media Relations CDC, Office of Communication (404) 639–3286

Each year, the Advisory Committee on Immunization Practices (ACIP) reviews the recommended childhood immunization schedule to address changes in the use of both previously- and newly-licensed vaccines. Since the immunization schedule was last published in January 1999, the ACIP, the American Academy of Family Physicians, and the American Academy of Pediatrics have made the following changes: (1) Rotavirus vaccine was removed from the schedule after it was found to be strongly associated with intussusception (a type of intestinal obstruction)among infants who had received the vaccine 1-2 weeks earlier; (2) An all-IPV (inactivated poliovirus vaccine) schedule for polio vaccination was endorsed to eliminate the rare complication with the oral vaccine (1 case/ 2.4 million doses) of vaccine-associated paralytic polio; (3) Acellular pertussis vaccines should be used exclusively; and (4) Hepatitis A vaccine was added to the schedule to reflect its recommended use in selected areas of the United States.

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