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MMWR – Morbidity and Mortality Weekly Report

1. Venous Thromboembolism in Hospitals — United States, 2007–2009

Division of News & Electronic Media
(404) 639-3286

Hospitalization is a major risk factor for venous thromboembolism and greater public health efforts are needed to prevent VTE among hospitalized patients. Hospitalized patients are known to be at higher risk of venous thromboembolism (VTE), which consists of deep vein thrombosis (a blood clot in a deep vein) and pulmonary embolism (the passage of a clot into the lungs).  The findings of this report indicate that from 2007 to 2009, there was an estimated average of 547,596 hospitalizations with a diagnosis of VTE each year among adults 18 years of age or older.  Of these, an annual estimated average of 348,558 hospitalizations had a DVT diagnosis and 277,549 had a PE diagnosis.  These findings emphasize the need for increasing awareness about VTE and for the development and implementation of evidence-based strategies for preventing VTEs among hospitalized patients.

2. Neonatal Herpes Simplex Virus Infection After Ritual Circumcisions that Included Direct Orogenital Suction — New York City, 2000–2011

Sam Miller, Assistant Commissioner for Public Affairs
Bureau of Public Affairs
New York City Department of Health and Mental Hygiene

In this analysis, New York City (NYC) Department of Health and Mental Hygiene (DOHMH) officials describe 11 cases of laboratory-confirmed herpes simplex virus (HSV) infection with 2 deaths among male newborns following Jewish ritual circumcision that included an ultra-Orthodox Jewish practice, metzitzah b’peh, in which the circumciser places his mouth directly on the newly circumcised penis and sucks blood away from the wound. Neonatal HSV is a potentially disabling, life-threatening infection, usually transmitted from mother-to-infant during delivery. However, evidence suggests that between 2000 and 2011, at least 11 infants in the city were infected with herpes through metzitzah b’peh. (“direct orogenital suction”) Ten of the infected infants were hospitalized and two died. Some of the infants’ parents were not aware that metzitzah b’peh would be a part of their child’s circumcision. Parents should be aware of the risk for neonatal herpes associated with direct orogenital suction and inquire in advance whether direct orogenital suction will be performed so the practice can be avoided. Physicians should counsel parents considering out-of-hospital newborn male circumcision about the risks of direct orogenital suction and should consider herpes infection when evaluating a newborn male infant with fever following Jewish ritual circumcision, and inquire about direct orogenital suction. Due to the risk of disease transmission, all newborn male circumcisions should be performed under sterile conditions.

3. Update: Influenza Activity — United States, 2011–12 Season and Composition of the 2012–13 Influenza Vaccine

Division of News & Electronic Media           
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The 2011–12 influenza season in the United States was one of the mildest and latest seasons on record.  Influenza A (H3N2) viruses predominated overall, but influenza A (H1N1)pdm09 (pH1N1) and influenza B viruses also circulated widely.  Compared with recent influenza seasons, this season had a lower percentage of outpatient visits for influenza-like illness, lower rates of hospitalizations, and fewer deaths attributed to pneumonia and influenza.  The number of pediatric deaths attributable to influenza this season was the lowest reported since data collection began in the 2004–05 season.  The majority of viruses analyzed was similar to those included in this year’s vaccine and were sensitive to antiviral drugs.  Vaccination remains the most effective way to prevent influenza and its complications.  All unvaccinated persons aged 6 months or older should be offered influenza vaccine throughout the influenza season. Annual influenza vaccination is still the best way to protect against influenza infections, hospitalizations, and deaths.

4. Potential Effects of Improvements in Weighting and Data Collection — Behavioral Risk Factor Surveillance System, 2011

Division of News & Electronic Media           
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The Behavior Risk Factor Surveillance Branch in the Division of Behavioral Surveillance made two refinements in the Behavioral Risk Factor Surveillance System (BRFSS), which provides health status, risk behaviors and chronic conditions information for all states. The first of these changes is adding interviews with cell phone respondents to the data. The second change to BRFSS methodology is adopting a more sophisticated and enhanced weighting method. Weighting is a statistical analysis process used to ensure that data gained from surveying a population segment is comparable to that of the overall population. The new process is called “iterative proportional fitting,” also called “raking.” These changes may affect state-level prevalence estimates and trend lines of chronic conditions and health risk behaviors. CDC anticipates small increases in trend lines for other indicators, such as tobacco use, obesity, binge drinking, HIV, asthma, and health status.


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