Synopsis for March 16, 2006

The MMWR is embargoed until Thursday, 12 PM EST.

1. Primary and Secondary Syphilis – United States, 2003-2004
2. Methamphetamine Use and HIV Risk Behaviors among Heterosexual Men – Five Northern California Counties, December 2001-November 2003
3. Increased Antiviral Medication Sales before the 2005-06 Influenza Season – New York City
4. Inhalation Anthrax Associated with Dried Animal Hides – Pennsylvania and New York City, 2006
5. Hypothermia-Related Deaths – United States, 2005
   

Primary and Secondary Syphilis – United States, 2003-2004

A CDC analysis released today emphasizes that the primary and secondary (P&S) syphilis rate in the United States increased for the fourth consecutive year in 2004.

The rate of P&S syphilis was up 8 percent, from 2.5 cases per 100,000 population in 2003 to 2.7 per 100,000 in 2004. The vast majority of the increase is attributable to a resurgence of syphilis among men who have sex with men (MSM). The rate of P&S syphilis increased 81 percent among men overall since the low in 2000. The analysis also points out that 2004 marked the end of a 13 year decline in syphilis rates among women and the first increase in the disparity in syphilis rates between African Americans and Whites since 1993. Prevention interventions addressing African Americans and MSM need to be enhanced, and health departments and providers should be vigilant about the detection and case reporting of syphilis in women to prevent an increase of the epidemic in heterosexuals. CDC is committed to the elimination of syphilis in the United States and is working with public health and community partners for all populations, particularly African Americans, MSM, and women.

Methamphetamine Use and HIV Risk Behaviors among Heterosexual Men – Five Northern California Counties, December 2001-November 2003

The Health Evaluation in Young Men (HEY-Man) Study, conducted by the California Department of Health Services, is one of the first population-based studies to show a link between methamphetamine (“meth”) use and high-risk sexual behaviors among heterosexuals.

Previous studies have demonstrated a similar association among men who have sex with men (MSM). Using preliminary data collected between December 2001 and November 2003, the HEY-Man analyses, which included 18- to 35-year-old heterosexual men from northern California, found that 15.6 percent of participants reported meth use, with six percent of men reporting use in the past six months (“recent users”). When compared with men who had never used meth, recent users were more likely to have had casual or anonymous sex partners (64.8 percent vs. 44.4 percent), multiple partners (56.9 percent vs. 26.3 percent), or partners who used injection drugs (11.1 percent vs. 1.7 percent) in the past six months; and to report having ever received drugs or money for sex (15.5 percent vs. 3.5 percent). Study authors recommend a greater emphasis on the association between meth use and HIV/STD risk among heterosexuals, in addition to MSM, and write that prevention services should include referrals for drug use prevention and treatment.

Increased Antiviral Medication Sales before the 2005-06 Influenza Season – New York City

Sales data for antivirals suggest that physicians were prescribing antivirals for stockpiling by their patients, which is not recommended practice. Physicians and the general public should not create personal stockpiles of antiviral medications.

Sales of prescription anti-influenza medications (or antivirals) increased markedly before the beginning of the 2005-06 influenza season in New York City (NYC). The arrival of influenza each year is reflected in laboratory test results of respiratory specimens, institutional outbreaks of influenza, and increased antiviral sales. In October 2005, increased antiviral sales were not accompanied by any of the other indicators of influenza activity. However, increased antiviral sales did coincide with media coverage of avian influenza due to H5N1 and a potential influenza pandemic. A similar but smaller increase in antiviral sales occurred in October 2004 during media coverage of a potential influenza vaccine shortage. A likely explanation for the increased sales was the creation of personal stockpiles of antiviral medications.

Inhalation Anthrax Associated with Dried Animal Hides – Pennsylvania and New York City, 2006

Inhalation anthrax is a rare infection. The safest way to eliminate risk of inhalation anthrax from animal hides or hair is to work only with hides that have been tanned or otherwise treated to render anthrax spores nonviable. Workers should further protect themselves by washing their hands regularly, wearing protective gloves and a separate pair of shoes in the workspace, and working in a well-ventilated space where others will not be present will.

The first case of naturally acquired inhalation anthrax since 1976 was identified on February 21, 2006 in a resident of New York City who was a traditional African drum maker and dancer. The individual was exposed to aerosolized anthrax spores in a non-ventilated studio when they scraped contaminated animal hides to remove hairs and make them into drums. Epidemiologic and environmental investigations determined that the only other people at risk of infection were those present during procedures that could have aerosolized anthrax spores (e.g., mechanical hide manipulation or sweeping/vacuuming of hairs); as a precaution, four people were identified and given postexposure prophlaxis. Further, there was no documented risk of inhalation anthrax from playing or owning African drums, or attending African dance performances.

Hypothermia-Related Deaths – United States, 2005

Hypothermia deaths are preventable.

Hypothermia, a preventable disequilibrium of the body’s temperature, has an average annual incidence of 0.4 per 100,000 population in the United States. Hypothermia is defined as a core body temperature less than 95F (less than35C). Signs of hypothermia include shivering, slurred speech, confusion, and impaired hand coordination. Excessive cold slows enzymatic activity throughout the body, leading to potentially fatal organ failure. Although advancements in rewarming and cardiopulmonary resuscitation have improved survival, the key to reducing mortality and morbidity is to protect the body from excessive cold exposure. Alcohol intake, activity level, and clothing characteristics are among the modifiable factors that can prevent hypothermia. In addition, vulnerable populations that may not be able to take care of themselves (the elderly, the homeless, the chronically ill, alcoholics, and drug users) need protection from hypothermia.

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