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MMWR – Morbidity and Mortality Weekly Report

1. Nationwide Rubella Epidemic — Japan, 2012–2013

CDC Media Relations

Rubella, usually a mild rash illness, can cause devastating consequences if pregnant females become infected early in pregnancy. These serious consequences include: miscarriage, stillbirth and infants born with congenital defects known as congenital rubella syndrome (CRS). In 1976, Japan introduced rubella vaccine into their national program targeting girls in junior high school. In 1989, MMR was introduced, targeting children. However, adult males remain susceptible. From January 1 to May 1, 2013, 5442 rubella cases have been reported with the majority (77%) occurring among adult males. Since October 2012, 10 CRS cases have been reported. To prevent rubella outbreaks by interruption of rubella virus transmission, high rubella immunity must be ensured across all age groups (both females and males). Countries and regions establishing a goal of accelerated rubella control or elimination should review their previous immunization policies and strategies to identify and vaccinate susceptible persons and to ensure high population immunity in all cohorts, both males and females.

2.Update to Interim Guidance for Preexposure Prophylaxis (PrEP) for the Prevention of HIV Infection: PrEP for Injecting Drug Users

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

No Summary Available

3.Mass Drug Administration for the Elimination of Lymphatic Filariasis — Port-au-Prince, Haiti, 2011–2012

CDC Media Relations

CDC has verified that the Haitian Ministry of Health has successfully scaled up its efforts to protect its entire population from the infectious and disabling parasitic disease, lymphatic filariasis (known as elephantiasis), despite continued challenges from the 2010 earthquake and an ongoing cholera outbreak. Using an innovative monitoring tool, CDC, Haiti's Ministry of Health, and several partners verified community-wide treatment coverage and identified strategies for achieving even greater coverage for future treatment rounds. Port-au-Prince was the hardest and last area to protect. Haiti is well on its way to stopping transmission of LF, which is spread by infected mosquitoes. Haiti has some of the highest LF rates in the world. Five rounds of treatment are required to eliminate this painful disease, which causes massively swollen limbs and scrotum after the parasite damages in the lymph system. Haiti's Ministry of Health has successfully taken the final and most difficult step towards eliminating lymphatic filariasis through mass drug administration, a public health best buy. CDC has confirmed that despite the earthquake and limited clean water needed for treatment, Haiti has completed at least an initial round of community coverage for its entire population and exceeded WHO guidelines.

4. Emergency Department Visits by Patients with Mental Health Disorders — North Carolina, 2008–2010

Judith E. Tintinalli, MD, MS
Professor, Department of Emergency Medicine

Of all emergency department (ED) visits in North Carolina from 2008-2010, nearly 1 in 10 visits were made by patients with underlying mental health disorders. ED visits by patients with mental health disorders increased by 18 percent, nearly four times the increase in the total number of ED visits in the state. Most of the ED visits (62 percent) were by patients with underlying stress, anxiety, or depression.  Almost one-third of ED visits by those with underlying mental health disorders resulted in hospital admission, twice as many as those without underlying mental health disorders. Those  65 years and older had the highest rates of stress, anxiety, depression, schizophrenia, and dementia compared to all other age groups, and one of every two elders with an underlying mental health disorder was admitted to the hospital. Mental health disorders are a serious public health problem, and patients with mental health disorders are visiting the ED in growing numbers. Tracking ED visits by patients with underlying mental health problems is an important measure of the success of community health care systems.  In North Carolina, the proportion of ED visits by those with underlying mental health disorders increased from 2008-2010, especially for those with disorders such as stress, anxiety, and depression. These disorders are better treated in community settings, and not in the ED.  The elderly are especially vulnerable, have the highest overall rates of mental health disorders compared to any other age group, and often require complex care that must be integrated across different medical specialties.  EDs need the resources to care for patients with mental health disorders. EDs should also be well integrated into the system of community health care in order to provide alternatives to hospital admission and to serve as the first step for outpatient care.

5. Influenza Activity — United States, 2012–13 Season, and Composition of the 2013–14 Influenza Vaccine

CDC Media Relations

During the 2012–13 , influenza A(H3) viruses predominated in the United States overall during the influenza season, followed by influenza B viruses, while pH1N1 viruses were identified rarely. Compared with recent influenza seasons, this season began earlier, and also had a higher percentage of outpatient visits for influenza-like illness, higher rates of hospitalizations, and more deaths attributed to pneumonia and influenza. The age group with the highest hospitalization rate were among people  65 years and older , accounting for more than half of all reported influenza-associated hospitalizations. The 2012–13 influenza season began early, and was relatively more severe than recent influenza seasons, particularly for people 65 years and older. This season is an example of the serious public health toll that influenza can take, and underscores the importance of influenza vaccination and treatment.

6. Notes from the Field

Outbreak of Poliomyelitis — Somalia and Kenya, May 2013



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