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MMWR – Morbidity and Mortality Weekly Report

1. Investigation of Viral Hepatitis Infections Possibly Related to Health-Care Delivery — New York City, 2008-2011

Alexandra Waldhorn
New York City Department of Health and Mental Hygiene

An approach to investigating potential cases of health care-related transmission of hepatitis B virus (HBV) or hepatitis C virus (HCV) that has been developed by the New York City Department of Health and Mental Hygiene (NYC DOHMH) may provide a useful resource to other health departments working to establish their own protocols.  Potential transmission of HBV and HCV in health care settings is of particular concern, and investigations into cases of possible transmission when they occur are critical to identify unsafe practices and avoid future transmission.  However, such investigations are resource-intensive and can overwhelm health departments.  To help guide the public health response to possible cases of health care-related HBV and HCV transmission in New York City, the NYC DOHMH has developed an approach that prioritizes carrying out the least resource-intensive activities for each suspected case, such as conducting initial patient and physician interviews.  Based on these initial findings, decisions to expand the investigation are made based on how likely the case represents part of a larger cluster of transmission; full investigations may include on-site visits to the medical practice, testing for other patients, analysis of blood specimens, and broad notification to other patients.  Authors use two case reports to illustrate the NYC DOHMH approach.


2. Multiple Outbreaks of Hepatitis B Virus Infection Related to Assisted Monitoring of Blood Glucose Among Residents of Assisted Living Facilities — Virginia, 2009–2011

Maribeth Brewster
Virginia Department of Health

Outbreaks of hepatitis B virus (HBV) infection among residents of four assisted living facilities (ALF) in Virginia underscore the importance of hepatitis surveillance in detecting outbreaks as well as the critical need for proper infection control in these settings.  Between February 2009 and November 2011, the Virginia Department of Health (VDH) was notified through routine viral hepatitis surveillance of cases of acute HBV infection among residents in four separate ALF in the central region of Virginia.  Upon receipt of these case reports, VDH, along with the local health departments and CDC, conducted thorough investigations to determine whether the infections resulted from possible transmission among residents.  Testing of residents at these facilities identified a total of 31 acute HBV infections; all were among residents receiving assisted monitoring of blood glucose for management of diabetes.  Lapses in infection control practices were observed at three of the four facilities.  The authors note that this highlights the important role of health departments in identifying unsafe practices and implementing appropriate infection control measures to avoid future transmission.  Other interventions that are critical in these settings include appropriate HBV vaccination for those at risk, improved infection control oversight and appropriate staff training, and prompt investigation of acute HBV infections to detect future outbreaks.

3. Drowning— United States, 2005–2009

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Drowning results in more deaths among children 1-4 years of age than any cause except birth defects, but early swimming lessons are effective in reducing this risk. In the US from 2005-2009, an average of 3,880 people died from unintentional drowning each year and more than 5,700 received emergency department care for nonfatal drowning. Overall, the death rate for males was four times that of females. Children 4 years old or younger had the highest rates of drowning; higher than any cause except birth defects.  Half of these incidents occurred in swimming pools. Finally, half of all nonfatal drowning victims treated in emergency departments required hospital admission or transfer for further care.  Because swimming pools (often at their own home) remain high risk locations for children 4 years old or younger and research shows that early formal swimming lessons reduce risk, public health and medical professionals should encourage and support swimming lessons as a life-saving skill along with other proven interventions.

4. Promotion of Healthy Swimming After a Statewide Outbreak of Cryptosporidiosis at Recreational Water Venues — Utah, 2008–2009

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More than 1 out of 5 (21.6 percent) Americans don’t know that swimming when they have diarrhea can make other swimmers sick; more than 1 out of 3 (34.1 percent) Americans don’t know that chlorine does not kill germs in pools instantly. If a person has diarrhea in the pool, the water can become contaminated with germs. Swallowing a single mouthful of contaminated water can cause diarrhea, meningitis, and other illnesses. Although chlorine kills most germs within minutes, some germs can survive for days in properly-chlorinated pools. This report focuses on the public’s knowledge about healthy swimming and looks at the potential to increase awareness through educational campaigns looking at Utah Department of Health’s and Utah’s Salt Lake Valley Health District’s healthy swimming promotion campaign.

5. Progress Toward Interruption of Wild Poliovirus Transmission — Worldwide, January 2011–March 2012

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Despite setbacks, there was progress toward polio eradication in 2011. Reported wild polio virus (WPV) cases decreased 52 percent worldwide in 2011. Cases in India reduced more than 98 percent, with the last identified case in January 2011; the country has been considered polio-free since February 2012. WPV type 3 cases declined 31 percent globally in 2011. Cases increased in 2011 in Afghanistan, Nigeria, and Pakistan. Outbreaks continued to occur because of importation from polio-reservoir countries to polio-free areas; 11 different outbreaks occurred in China and in eight polio-free countries in Africa during 2011. During January–March 2012, all WPV cases were reported from Afghanistan, Chad, Nigeria and Pakistan. Persistent WPV circulation in 2012, particularly in Nigeria and Pakistan, poses an ongoing threat to eradication efforts. Current efforts are also threatened by shortages in funds. Global polio eradication can be completed on schedule if polio-affected countries and countries at risk of poliovirus outbreaks fully and urgently implement their national emergency plans that incorporate mechanisms for increased accountability.


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