Synopsis for March 19, 2004

The MMWR is embargoed until Thursday, 12 PM EST.

1. Trends in Tuberculosis ― United States, 1998-2003
2. Tuberculosis Outbreak in a Community Hospital — District of Columbia, 2002
3. School-Associated Pertussis Outbreak ― Yavapai County, Arizona, September 2002-February 2003
4. Evaluation of an Association Between Loratadine and Hypospadias ― United States, 1997-2001

Synopsis for March 19, 2004

Trends in Tuberculosis ― United States, 1998-2003

TB rates continue to fall, but decline is slowing and disparities remain

After a decade of falling rates, the rate of decline of active tuberculosis (TB) cases in the country is slowing. New CDC surveillance data for 2003 show that 14,871 persons with active TB disease were reported in the United States, a number comparable to the 15,075 persons with TB recorded in 2002. Overall, the national TB rate was 5.1 cases per 100,000 people in 2003, a slight decline of 1.9 percent in case rate since 2002. This is the smallest one-year decline since 1992, the peak of the 1985-1992 TB resurgence in the United States. Despite the overall decline nationwide, there are significant geographic, racial and ethnic disparities, and cases have actually increased in some parts of the country. TB rates among foreign-born persons remain disproportionately high, at nearly nine times the rate of U.S.-born persons. Among U.S.-born TB patients, non-Hispanic blacks had a case rate almost eight times higher than for non-Hispanic whites.

Tuberculosis Outbreak in a Community Hospital — District of Columbia, 2002

Patient with TB in a large community hospital exposes health-care workers and patients

Four patients and one health care worker in a large, urban U.S. teaching hospital were diagnosed with TB disease after more than 1,000 patients and hospital staff were exposed to a patient with TB in 2002. The patient's TB disease may have gone undiagnosed during an earlier stay because HIV infection may cause atypical presentations of TB. There is a need for careful diagnosis that considers possible TB-HIV coinfection, especially among patients with HIV who have pulmonary symptoms or unexplained fever and weight loss. One patient with TB disease has potential to come into contact with a large number of patients and staff in a hospital setting, as in this situation. The resulting secondary TB cases among hospitalized patients and hospital staff illustrates that heightened awareness and vigilance is required by health-care workers to promptly identify and treat suspected TB cases.

School-Associated Pertussis Outbreak ― Yavapai County, Arizona, September 2002-February 2003

In adolescents or adults, pertussis should be considered as the cause of cough illness lasting >2 weeks, especially if the coughing is accompanied by a "whoop" sound, or if the person experiences spasms of coughing or vomiting after coughing.

Public health authorities in Arizona successfully implemented measures to control an outbreak of pertussis which began in a middle school in Yavapai County and spread to others in the community. Pertussis, or "whooping cough", is a serious bacterial respiratory infection characterized by severe spasms of cough that can last for a few weeks to several months. Infants (aged <1 year) are at greatest risk from pertussis; infants have the highest incidence of the disease and account for the overwhelming majority of pertussis-related hospitalizations, serious complications, and deaths. DTaP vaccine prevents the complications of pertussis and is recommended for all infants. However, vaccine protection against pertussis wanes over time. Among older children and adults whose protection has waned, pertussis can cause a range of symptoms from mild to severe cough. Middle and high school-associated pertussis outbreaks are increasingly recognized and reported. Such outbreaks often result in a large number of cases among adolescents and subsequent spread to the community with cases among infants aged <1 year. This was the situation in the Yavapai County outbreak which began in a middle school in September 2002 and resulted in 485 pertussis cases (113 cases in students). Delay in recognizing pertussis outbreaks in schools occurs because patients do not seek medical care early when they are contagious, the diagnosis of pertussis is not considered, and diagnostic testing can be inaccurate. Health-care providers should consider pertussis in persons of any age with an acute cough illness. Early recognition and treatment can help prevent transmission of pertussis to others; including young infants who are most at risk.

Evaluation of an Association Between Loratadine and Hypospadias ― United States, 1997-2001

In a large national birth defects study, loratadine, an allergy medication sold under the brand name Claritin, was not associated with hypospadias, a birth defect where the urethral opening is not at the tip of the penis.

Despite the fact that use of both prescription and nonprescription medications during pregnancy is relatively common, there is very little known about the possible effects of most medications on the unborn child. Loratadine, an allergy medication sold under the brand name Claritin, is frequently used by reproductive aged women, and there may be many inadvertent exposures early in pregnancy prior to recognition of the pregnancy. A recent European study suggested a possible association between loratadine and hypospadias, a birth defect where the urethral opening is not at the tip of the penis. Data from CDC's National Birth Defects Prevention Study, a large national birth defect study, was used to examine this possible association. Information on the use of Claritin during pregnancy was analyzed for 563 boys with hypospadias and 1444 boys who did not have a major birth defect. No increased risk was seen, even after adjusting for birth month, maternal age, maternal race/ethnicity and study center. These results may be useful for women and health care providers to reduce the anxiety that may occur following inadvertent exposures to loratadine during pregnancy. However, as with any medication, women should consult their health care provider before any medication use during pregnancy.

Media Home | Accessibility | Privacy Policy | Contact Us
CDC Home | Search | Health Topics A-Z

This page last reviewed March 18, 2004
URL: http://www.cdc.gov/media/mmwrnews/n040319.htm

Centers for Disease Control and Prevention
Office of Communication