Synopsis for March 31, 2000

MMWR articles are embargoed until 4 p.m. E.S.T. Thursdays.

1. Use of Hospital Discharge Data to Monitor Uterine Rupture Massachusetts, 1990-1997
2. Imported Dengue United States, 1997 and 1998
3. Progress Toward Poliomyelitis Eradication Democratic Republic of the Congo, 1999
4. Public Opinion About Public Health United States, 1999

Reports and Recommendations
Synopsis for March 31, 2000

Backgrounder for CDC Recommendations Regarding Selected Conditions Affecting Women’s Health

Synopsis for March 31, 2000

Use of Hospital Discharge Data to Monitor Uterine Rupture Massachusetts, 1990-1997

ICD-9-CM codes related to uterine rupture are not specific enough for purposes of monitoring uterine ruptures, therefore hospital discharge data should not be used by itself to monitor trends in uterine ruptures.

 

PRESS CONTACT:  Linda Bartlett, MD, MHSc  CDC, National Center for Chronic Disease and Health Promotion (770) 488–5187

In response to the rising number of cesarean births, the obstetrical and public health community began a concerted effort to decrease the number of women delivering by cesarean including encouraging women who had a previous cesarean birth to attempt a vaginal birth after cesarean (VBAC). VBAC is generally considered safe practice, and studies have found that 75% of women attempting VBACs are successful. The most serious complication with VBAC is uterine rupture occurring in approximately 1% of women who attempt this method of delivery. An increase in VBAC in Massachusetts prompted concern that there might be a corresponding increase in uterine rupture. Using ICD-9-CM codes in hospital discharge data to identify potential cases of uterine rupture, the authors found that the number of uterine rupture increased steadily during 1990-1997. However, a statewide review of medical records for these cases found that only 40% actually had a uterine rupture. These findings indicate that hospital discharge data lack adequate specificity for monitoring trends in uterine rupture. In addition, the researchers found that uterine rupture occurred in less than one percent of women delivering in Massachusetts who had a previous cesarean birth. Further study is underway to understand why some women have uterine ruptures in order to learn how to prevent uterine ruptures.

Imported Dengue United States, 1997 and 1998

Dengue can occur in U.S. residents returning from tropical areas and physicians can send serum samples for confirmation to CDC (through the state health department laboratory).

 

PRESS CONTACT: Enid Garcia, MD, MPHJames CDC, National Center for Infectious Disease (787) 766–5181

Dengue, an acute viral disease transmitted by mosquitoes can occur in US residents returning from tropical areas. Serum samples from 349 cases of suspected dengue based on clinical presentation during 1997 and 1998 were submitted to CDC. Of these 143 (41%) were serologically or virologically diagnosed as dengue. All four dengue virus serotypes were isolated. The most common clinical manifestations were fever, headache, myalgia and rash. At least seven persons were hospitalized and one patient died in 1998. Travel histories available indicated that most infections were acquired in the Caribbean Islands and Asia. The prevention of dengue relies on avoidance of exposure to mosquitoes. Physicians should consider dengue in the differential diagnosis for patients who have compatible manifestations and a history of travel to tropical areas. Serum samples should be sent for confirmation through the state health department laboratory to the Dengue Branch, CDC. 

Progress Toward Poliomyelitis Eradication Democratic Republic of the Congo, 1999

The progress toward polio eradication reported from DRC during 1999 is encouraging and suggests that polio eradication can be achieved even in countries experiencing civil unrest and armed conflict.

 

PRESS CONTACT: Roland Sutton, MD, MPH, HT&M CDC, National Center for Infectious Disease (404) 639–8762

In 1988, the World Health Assembly, the governing body of the World Health Organization (WHO) resolved to eradicate poliomyelitis globally by the year 2000. Substantial progress has been reported to date in implementing the recommended eradication strategies: 1) achieving and maintaining high routine vaccination coverage among infants; 2) implementing National Immunization Days (NIDs) to rapidly decrease widespread poliovirus circulation; 3) establishing sensitive surveillance system for acute flaccid paralysis (AFP); and 4) conducting "mopping-up" to eliminate the final chains of poliovirus transmission. Three WHO Regions are now free of polio, including the Western hemisphere (Region of the Americas) since 1991; the Western Pacific Region since 1997; and in the European Region since November 1998. Unfortunately, progress in countries affected by conflict and war is been slower. The Democratic Republic of Congo (DRC) was only able to implement full NIDs in 1999; three NIDs rounds were conducted one each in August, September and October reaching an estimated 71%, 86%, and 81% of the target population (children 0-59 months of age), respectively. Similarly, AFP surveillance was expanded nationwide in 1999 (and already 9 of 11 provinces are reporting cases). Increased efforts are planned for 2000 in DRC to reach the polio eradication target by the end of 2000 or shortly thereafter.

Public Opinion About Public Health United States, 1999

Next week is National Public Health Week. According to a 1999 survey commissioned by the Pew Charitable Trusts, a Philadelphia-based philanthropy, a majority of American's believe the nation's public health system has been neglected and is more deserving of additional funding.

 

PRESS CONTACT: Shelly Hearne, PhD John Hopkins University, School of Public Health (410) 955-6878

Next week is National Public Health Week. According to a 1999 survey commissioned by the Pew Charitable Trusts, a Philadelphia-based philanthropy, a majority of American's believe the nation's public health system has been neglected and is more deserving of additional funding. The Charitable Trusts asked that the research explore perceptions about public health in general, including levels of support and importance compared to other national priorities; opinions about environmental health and its role, if any, in causing disease and promoting health; and viewpoints regarding the public health infrastructure. After being given a definition of public health system; 1) there is concern about the quality of the public health system; 2) increased government spending for public health is a greater priority than other key national concerns; and 3) environmental factors are important contributors to certain health problems.

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