MMWR News Synopsis
Friday, February 14, 2020
- Travel-Associated and Locally Acquired Dengue Cases — United States, 2010–2017
- State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018
- Trends in Incidence of Type 1 and Type 2 Diabetes Among Youths — Selected Counties and Indian Reservations, United States, 2002–2015
- Persons Evaluated for 2019 Novel Coronavirus — United States, January 2020
- Recommendations and Reports
- Notes from the Field
CDC Media Relations
During 2010 to 2017, there were nearly 400 locally acquired and more than 5,000 travel-associated dengue cases in 50 U.S. states and the District of Columbia. Mosquitoes that spread dengue are present in more than half of all U.S. counties and, with increasing travel of U.S. residents to tropical countries, the risk of dengue in the United States may increase. Locally acquired dengue cases in the continental United States are not common but small, focal outbreaks do occasionally occur. Most cases among travelers were associated with travel to the Caribbean and to Asia. Dengue can cause severe or fatal disease. Risk for local transmission increases when people infected with dengue return to the United States and are bitten by mosquitoes. Dengue outbreaks are reported throughout many countries of the world. People living in or traveling to areas with risk of dengue can protect themselves from mosquito bites by using an Environmental Protection Agency-approved insect repellent, wearing long-sleeved shirts and long pants, using air conditioning when possible, and staying in places with screens. Clinicians should consider dengue in patients with a non-specific acute febrile illness with nausea, vomiting, rash, myalgias, or arthralgias who are returning from tropical and subtropical areas where dengue occurs.
State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018
CDC Media Relations
State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers could reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures. To monitor changes in state Medicaid tobacco cessation coverage for traditional Medicaid enrollees over the past decade, researchers collected data on coverage of nine proven cessation treatments (individual and group counseling and seven U.S. Food and Drug Administration–approved medications) by state Medicaid programs. States that cover all nine cessation treatments are considered to have comprehensive coverage. Data regarding barriers to accessing covered treatments (e.g., copayments and prior authorization) were also collected. As of December 31, 2018, a total of 15 states covered all nine treatments for all enrollees, up from six states as of December 31, 2008. Of these 15 states, Kentucky and Missouri were the only states to have removed all seven barriers to accessing these cessation treatments.
Trends in Incidence of Type 1 and Type 2 Diabetes Among Youths — Selected Counties and Indian Reservations, United States, 2002–2015
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From 2002 through 2015, new cases of type 1 and type 2 diabetes increased at constant rates in U.S. children and adolescents, and the rates of increase were generally higher in racial/ethnic minority populations than in whites. Diabetes is one of the most common chronic diseases among people younger than 20 years. Onset of diabetes in childhood and adolescence is associated with numerous complications, including diabetic kidney disease, retinopathy, and peripheral neuropathy and poses a substantial impact on public health resources. Previous data indicated that from 2002 to 2012 type 1 and type 2 diabetes incidence increased 1.4% and 7.1%, respectively, among U.S. youths. To assess recent trends in incidence of diabetes in youths, researchers analyzed 2002–2015 data from the SEARCH for Diabetes in Youth Study. The incidence of both type 1 and type 2 diabetes in U.S. youths continued to rise at constant rates throughout this period. For both type 1 and type 2 diabetes, the rates of increase were generally higher in racial/ethnic minority populations than in whites. These findings highlight the need for continued surveillance for diabetes among youths to monitor overall and group-specific trends, identify factors driving these trends, and inform health care planning.
CDC Media Relations
- Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020
New guidelines from CDC and the National Tuberculosis Controllers Association for the treatment of latent tuberculosis infection (LTBI) recommend shorter regimens (three to four months) over longer regimens (six to nine months) for most patients living in the United States. The new LTBI treatment guidelines are based on a review of 63 studies of regimens for the treatment of LTBI. Shorter, rifamycin-based treatment regimens are recommended because of their effectiveness, safety, and high treatment completion rates. Longer regimens, although highly effective, have higher toxicity risk and lower treatment completion rates. CDC last published comprehensive LTBI treatment guidelines in 2000. Shorter LTBI treatment regimens with higher completion rates will facilitate TB elimination in the United States. CDC estimates up to 13 million people have LTBI in the United States.
- Carbapenem-Resistant Klebsiella pneumoniae with mcr-1 Gene Identified in a Hospitalized Patient — Wyoming, January 2019
In December of 2018, Wyoming identified the state’s first case of carbapenem-resistant Enterobacteriaceae—also known as CRE or the “nightmare bacteria”—containing mcr-1, which is a gene that can make bacteria resistant to colistin, a drug that can be the last resort for some multidrug-resistant infections like CRE. The presence of mcr-1 in CRE could promote the development of untreatable, pan-resistant infections. In mid-December 2018, an adult patient was admitted to a Wyoming hospital with acute confusion. Because of a history of methicillin-resistant Staphylococcus aureus (MRSA), the patient was placed on contact precautions and kept in a private room. The patient was found to have an infection caused by carbapenem-resistant Klebsiella pneumoniae, and further testing identified that the bacteria carried the mcr-1 gene. The Wyoming Department of Health began an investigation using CDC guidance and did not identify any additional patients with the bacteria. The investigation was not able to determine where the patient acquired the bacteria, though frequent antibiotic use for recurrent urinary tract infections may have increased the patient’s risk for contracting antibiotic-resistant bacteria. The patient recovered and was discharged in January 2019.
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