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MMWR – Morbidity and Mortality Weekly Report

1.Trends in Tuberculosis — United States, 2012

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Data indicate that TB reached an all-time low in the United States in 2012 after 20 consecutive years of declines, although certain populations – including racial/ethnic minorities and foreign-born individuals -- continue to be significantly affected.  Preliminary data from the CDC National TB Surveillance System indicate a total of 9,951 TB cases were reported in the United States in 2012, marking a 6.1 percent decline in the rate from 2011 (to 3.2 cases per 100,000 population).  However, despite this progress, TB rates for all racial/ethnic minorities were higher than those of whites, with TB rates seven times higher for both Hispanics and blacks, and 25 times higher for Asians.  Foreign-born individuals are disproportionately affected, with a TB rate 12 times higher than among those born in the U.S.  Persons infected with HIV and the homeless are also especially vulnerable to TB.  Although the proportion of cases that were drug resistant remained relatively small, drug resistance is a concern because it is more difficult and costly to treat, and more often fatal.  In 2011, multidrug-resistant TB accounted for 1.6 percent of cases, or 127 total cases.  One case of extensively-drug resistant TB was reported in 2012.  The authors note that TB prevention and control efforts have averted more than 200,000 TB cases in the United States over the past 20 years. Also, continued vigilance and strong public health systems are needed to maintain this progress and to further reduce TB.

2. Tuberculosis Control Activities Before and After Hurricane Sandy — Northeast and Mid-Atlantic States, 2012

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Despite challenges posed by Hurricane Sandy in 2012, TB control staff in the Northeast and Mid-Atlantic states helped ensure continuity of TB treatment for 1,899 patients with active or suspected TB disease or with latent TB infection in the affected areas. Public health efforts at the time of natural disasters are critical to minimize the spread of communicable diseases, including TB, because displaced persons may congregate in shelters and resettle in new communities. Treatment for TB, which is often administered through directly-observed therapy (DOT), is particularly challenging at these times because of the long course of treatment required, often using multiple drugs. At the time of Hurricane Sandy, CDC worked with TB control staff in state and local health departments to help assess needs and ensure continuity of patient care. Many programs took advance measures to ensure continuity of care, such as having back-up copies of patient records, giving patients medications to self-administer in case DOT was interrupted, and moving essential TB supplies to safer areas. Due to proper emergency planning, treatment of patients continued, and by one week, all TB programs resumed full patient care operations. These findings underscore the importance of having strong TB control programs in place in order to ensure appropriate diagnosis, treatment, and prevention of TB, especially in times of a disaster.

3. Awareness of Prediabetes — United States, 2005–2010

Division of News & Electronic Media           

In 2010, about one in three U.S. adults aged 20 years and older, or an estimated 79 million people, had prediabetes, a condition in which their blood glucose or hemoglobin A1c levels are higher than normal but not high enough to be classified as diabetes. New research showed that only 11 percent of persons with prediabetes were aware that they had prediabetes. Furthermore, awareness of prediabetes was low (<14 percent) regardless of educational level, income level, health insurance status, or health care access status. Americans with prediabetes, including those with regular access to health care, might benefit from efforts aimed at making them aware that they are at risk of developing type 2 diabetes and that they can reduce their risk by making modest lifestyle changes. Efforts are needed to increase awareness. The vast majority of persons with prediabetes are unaware of their condition. Persons unaware of their risk should talk with their health care provider about the risk factors for developing type 2 diabetes. People aged 45 years and older or those who are overweight or obese and have other risk factors should speak with their doctor about getting tested. For type 2 diabetes. People with prediabetes can reduce their risk of developing type 2 diabetes by making modest lifestyle changes, such as modest weight loss, healthy food choices, and increased physical activity.

4. Notes from the Field: Multistate Outbreak of Salmonella Infantis, Newport, and Lille Infections Linked to Live Poultry in Backyard Flocks Sourced from a Single Mail-Order Hatchery—March—September, 2012

Division of News & Electronic Media

Notes from the Field

Live poultry, including chicks and ducklings, are sources of Salmonella infections, which can cause serious illness in young children, older adults, or persons who have weakened immune systems. People should wash their hands thoroughly with soap and water right after touching live poultry or anything in the area where these animals live and roam. The report describes an outbreak of three clusters of human Salmonella infections in the United States between March and September 2012 linked to backyard flocks from a single mail-order hatchery.  From March 1-September 24, 2012, a total of 195 persons infected with the outbreak strains of Salmonella serotypes Infantis, Newport, and Lille were reported from 27 states. This outbreak highlights the largest number of human illnesses linked to contact with live poultry during a single outbreak, and the ongoing risk for human salmonellosis linked to backyard flocks. Eighty-seven percent of ill persons with available purchase information reported buying chicks or ducklings sourced from a single mail-order hatchery in Ohio, which has been recently linked to other Salmonella outbreaks. Preventing these infections will require an integrated approach at the hatchery, agricultural feed store, and consumer levels.



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