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HICNet Medical News Digest      Wed, 18 Jan 1995        Volume 08 :
Issue 03

Today's Topics:

  [MMWR 23 Dec 94] Cigarette Smoking Among Adults
  [MMWR] Abortion Surveillance - Preliminary Data
  [MMWR] Trends Among Women Who Did Not Receive Prenatal Care
  [MMWR] Bolivian Hemorrhagic Fever
  CancerNet Update for January, 1995
  Q&A About AIDS Saliva Test
  Clinical Alert - Ischemic Optic Neuropathy Decompression Trial
Findings

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----------------------------------------------------------------------

Date: Wed, 18 Jan 95 06:51:02 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR 23 Dec 94] Cigarette Smoking Among Adults
Message-ID: <[e-mail]>

             Cigarette Smoking Among Adults -- United States, 1993

     The annual prevalence of cigarette smoking among adults in the
United
States declined 40% during 1965-1990 (from 42.4% to 25.5%) (1) but was
virtually unchanged during 1990-1992 (2). To determine the prevalence
of
smoking among adults, smoker interest in quitting, and the prevalence
of
cessation (i.e., quit ratio) among adults during 1993, the Year 2000
Health
Objectives Supplementof the 1993 National Health Interview Survey
(NHIS-2000) collected self-reported information about cigarette
smoking
from a random sample of civilian, noninstitutionalized adults aged
greater
than or equal to 18 years. This report presents the prevalence
estimates
for 1993 and compares them with estimates from the 1992 Cancer
Epidemiology
Supplement and presents 1993 estimates for smoker interest in quitting
completely and the prevalence of cessation among ever smokers.
     The overall response rate for the 1993 NHIS-2000 (n=20,860) was
81.2%.
For 1993, current smoking status was determined through two questions:
"Have you smoked at least 100 cigarettes in your entire life?" and "Do
you
now smoke cigarettes every day, some days, or not at all?" Ever
smokers
were persons who reported having smoked at least 100 cigarettes during
their entire lives. Current smokers were defined as those who had
smoked
100 cigarettes and now smoked either every day (i.e., daily smokers)
or
some days (i.e., some-day smokers). Former smokers had smoked at least
100
cigarettes in their lives but did not currently smoke. The prevalence
of
cessation was the percentage of former smokers among ever smokers.
Interest
in quitting smoking was assessed using answers to the question "Would
you
like to completely stop smoking cigarettes?" Data were adjusted for
nonresponse and weighted to provide national estimates. Confidence
intervals (CIs) were calculated using standard errors generated by the
Software for Survey Data Analysis (SUDAAN) (3).
     Prevalence estimates for 1992 were based on two definitions of
current
smoking and were calculated by averaging the estimates generated by
each
definition (2). One of the 1992 definitions of current smoking
(smoking
every day or some days) was identical to the definition used in 1993;
these
estimates are compared in this report.
     In 1993, an estimated 46 million (25.0% [95% CI= plus or minus
0.7%])
adults in the United States were current smokers (Table 1): 20.4% (95%
CI=
plus or minus 0.7%) were daily smokers, and 4.6% (95% CI= plus or
minus
0.3%) were some-day smokers. Smoking prevalence was significantly
higher
among men (27.7% [95% CI= plus or minus 1.1%] [24 million men]) than
among
women (22.5% [95% CI= plus or minus 0.9%] [22 million women]) (Table
1).
The racial/ethnic group-specific prevalence was highest among American
Indians/Alaskan Natives (38.7% [95% CI= plus or minus 8.7%]) and
lowest
among Asians/Pacific Islanders (18.2% [95% CI= plus or minus 4.1%]).
The
prevalence of smoking among persons with less than or equal to 8 years
of
education was significantly lower than that among persons with 9-15
years
of education; however, among persons with greater than or equal to 9
years
of education, prevalences varied inversely with education level. For
all
groups, the prevalence of smoking was highest among males who had
dropped
out of high school (42.1% [95% CI= plus or minus 4.4%]). Smoking
prevalence
was higher among persons living below the poverty level* (32.1% [95%
CI=
plus or minus 2.4%]) than among those living at or above the poverty
level
(23.8% [95% CI= plus or minus 0.8%]).
     The prevalence of current smokers in 1993 was unchanged
statistically
from 1992 (25.0% and 26.3%, respectively). However, the prevalence of
daily
smoking in 1993 (20.4% [95% CI= plus or minus 0.7%]) was significantly
lower than in 1992 (22.3% [95% CI= plus or minus 0.9%]). In addition,
prevalence estimates for current smokers during 1993 were lower
overall for
women, persons with a college education or higher, total persons
living at
or above the poverty level, and women living at or above the poverty
level
(Table 1).
     Of current smokers, an estimated 32 million persons (69.7% [95%
CI=
plus or minus 1.6%]) reported they wanted to quit smoking completely.
Women
were more likely to report an interest in quitting (72.7% [95% CI=
plus or
minus 1.9%]) than men (67.1% [95% CI= plus or minus 2.2%]). Current
smokers
aged greater than or equal to 65 years (49.9% [95% CI=5.8%]) were the
least
likely to report that they wanted to completely stop smoking.
     In 1993, an estimated 46 million adults were former smokers
(49.6%
[95% CI= plus or minus 1.2%] of ever smokers) (Table 2). The
prevalence of
cessation was higher among men (51.9% [95% CI= plus or minus 1.5%]),
whites
(51.6% [95% CI= plus or minus 1.3%]), and persons living at or above
the
poverty level (52.4% [95% CI= plus or minus 1.2%]), and increased
directly
with age. Among education levels, the prevalence of cessation was
lowest
among persons with 9-11 years of education (38.2% [95% CI= plus or
minus
3.3%]).

Reported by: Epidemiology Br, Office on Smoking and Health, National
Center
for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note: Although the overall prevalence of current smoking did
not
change from 1992 to 1993, the prevalence of daily smoking declined
during
1993, possibly reflecting the proliferation of restrictive worksite
and
public smoking policies (4). In addition, the relatively greater
decline
among women is consistent with a previous report that, in workplace
settings, women may be more likely to quit smoking because of worksite
smoking bans (5).
     Differences in prevalence among racial/ethnic groups may be
influenced
by differences in education levels and socioeconomic status, as well
as by
social and cultural phenomena. For example, in a recent report (6),
the
prevalence of behavioral risk factors, including cigarette smoking,
was
generally higher among persons with less than or equal to 12 years of
education.
     From 1992 to 1993, daily smoking prevalence increased among high
school seniors from 17.2% to 19.0% (1). To be effective, school-based
prevention programs should begin in kindergarten and continue through
high
school. This intervention should be especially intensive in middle
school
and should be reinforced in high school. CDC has published guidelines
for
incorporating tobacco-use prevention and cessation strategies in the
early
grades in schools (7). School-based programs should provide
instruction
about the short- and long-term physiologic and social consequences of
tobacco use, social influences on tobacco use, peer norms regarding
tobacco
use, and refusal skills.
     The findings in this report are subject to at least two
limitations.
First, because the 1992 and 1993 estimates are based on data collected
during a 6-month period, these estimates may not be representative of
annual prevalence. In particular, other data suggest that the
restriction
of the surveys to these periods may have minimized the true magnitude
of
declines in prevalence (National Household Survey on Drug Abuse,
unpublished data, 1992 and 1993). Second, because these estimates are
based
on self-reported data, prevalences may be underestimated. However,
underreporting is believed to be low in national prevalence surveys
(8).
     To sustain the decline in smoking prevalence, efforts must be
intensified to discourage initiation and to promote cessation.
Although 70%
of smokers want to stop smoking and 34% attempt to quit each year,
only
2.5% successfully stop smoking each year (9). The high rate of relapse
is
a consequence of the effect of nicotine dependence. Smokers who need
assistance with stopping can receive self-help materials from local
voluntary agencies, CDC (telephone [800] 232-1311 or [404] 488-5705),
and
the National Institutes of Health (telephone [800] 422-6237). Many
smokers
are addicted to nicotine and could potentially benefit from nicotine
replacement therapy (NRT); NRT and other cessation assistance can be
obtained from physicians and dentists. Information about formal
cessation
programs can be obtained from local voluntary agencies or health-care
providers.
     The health risks of cigarette smoking can be eliminated only by
quitting; switching to lower "tar" and nicotine cigarettes is not a
safe
alternative (10). Comprehensive measures for promoting cessation and
reducing the prevalence of smoking include increasing tobacco excise
taxes,
enforcing minors' access laws, restricting smoking in public places,
restricting tobacco advertising and promotion, and conducting
counter-advertising campaigns.

References
 1. Giovino GA, Schooley MW, Zhu B-P, et al. Surveillance for selected
tobacco-use behaviors--United States, 1900-1994. MMWR 1994;43(no. SS-
3).
 2. CDC. Cigarette smoking among adults--United States, 1992, and
changes
in the definition of current cigarette smoking. MMWR 1994;43:342-6.
 3. Shah BV. Software for Survey Data Analysis (SUDAAN), version 5.50
[Software documentation]. Research Triangle Park, North Carolina:
Research
Triangle Institute, 1991.
 4. Evans NJ, Gilpin E, Pierce JP, et al. Occasional smoking among
adults:
evidence from the California Tobacco Survey. Tobacco Control
1992;1:169-75.
 5. Brenner H, Mielck A. Smoking prohibition in the workplace and
smoking
cessation in the Federal Republic of Germany. Prev Med 1992;21:252-61.
 6. CDC. Prevalence of selected risk factors for chronic disease by
education level in racial/ethnic populations--United States, 1991-
1992.
MMWR 1994;43:894-9.
 7. CDC. Guidelines for school health programs to prevent tobacco use
and
addiction. MMWR 1994;43(no. RR-2).
 8. CDC. The health benefits of smoking cessation: a report of the
Surgeon
General, 1990. Rockville, Maryland: US Department of Health and Human
Services, Public Health Service, 1990; DHHS publication no. (CDC)90-
8416.
 9. CDC. Smoking cessation during previous year among adults--United
States, 1990 and 1991. MMWR 1993;42:504-7.
10. US Department of Health and Human Services. The health
consequences of
smoking: the changing cigarette--a report of the Surgeon General,
1981.
Rockville, Maryland: US Department of Health and Human Services,
Public
Health Service, 1981; DHHS publication no. (PHS)81-50156.

*Poverty statistics are based on a definition originated by the Social
Security Administration in 1964, subsequently modified by federal
interagency committees in 1969 and 1980, and prescribed by the Office
of
Management and Budget as the standard to be used by federal agencies
for
statistical purposes.



------------------------------

Date: Wed, 18 Jan 95 06:51:49 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Abortion Surveillance - Preliminary Data
Message-ID: <[e-mail]>

    Abortion Surveillance: Preliminary Data -- United States, 1992

     For 1992, CDC received data about legal induced abortions from 52
reporting areas (the 50 states, New York City, and the District of
Columbia). This report presents preliminary data for 1992.
     In 1992, a total of 1,359,145 legal abortions were reported to
CDC
(Table 1), a decrease of 2.1% from the number reported for 1991 (1),
and
the number of live births decreased by 1.1% (2). As a result, the
national
abortion ratio (number of legal abortions per 1000 live births)
decreased
from 339 in 1991 to 335 in 1992 (Figure 1). The national abortion rate
(number of legal abortions per 1000 women aged 15-44 years) also
declined
from 24 in 1991 to 23 in 1992. This rate increased each year from 1972
to
1980 (when it peaked [25]); since 1980, the rate has remained stable,
fluctuating from 23 to 24. As in previous years, approximately 92% of
women
who had a legal abortion were residents of the state in which the
procedure
was performed.
     Women who obtained legal abortions in 1992 were predominately
aged
less than 25 years, white, and unmarried. Compared with 1991, a lower
proportion of women who had abortions in 1992 had had live-born
children
(48% and 46%, respectively). Curettage (suction and sharp) remained
the
primary abortion procedure (approximately 99% of all such procedures).
As
in previous years, approximately half of legal abortions were
performed
during the first 8 weeks of gestation (Table 1): 14% of abortions were
performed at less than or equal to 6 weeks, 15% at 7 weeks, and 21% at
8
weeks' gestation. As in previous years, approximately 89% of abortions
were
performed during the first 12 weeks of pregnancy.

Reported by: Statistics and Computer Resources Br, Div of Reproductive
Health, National Center for Chronic Disease Prevention and Health
Promotion, CDC.

Editorial Note: The annual number of abortions in the United States
has
remained relatively stable since 1980, varying each year by less than
or
equal to 5%. However, since 1990 (the year in which the number of
abortions
was highest), the number of abortions has decreased each year. In
1992, the
national ratio of abortions to live births was lower than for any year
since 1977, indicating that a greater proportion of pregnancies ended
in
a live birth (3). The national fertility rate (number of live births
per
1000 women of reproductive age [15-44 years]) also peaked in 1990 and
has
declined somewhat since then (2).
     As in previous years, most women who obtained an abortion were
white.
However, the abortion rate for black women is approximately three
times
that for white women (CDC, unpublished data, 1991). Differences in
abortion
by race may reflect differences in socioeconomic status, education
level,
contraceptive use, and access to family planning, contraceptive, and
abortion services.
     Although the total number of legal induced abortions during 1992
was
available for all 52 reporting areas, approximately 26% of the
abortions
were reported from states that do not have centralized reporting;
these
areas could not provide information on the characteristics of women
obtaining abortions. Interpretation of temporal comparisons is
constrained
because the number of states that report characteristics varies each
year.
     Many states emphasize the prevention of unintended pregnancy,
particularly among teenagers. Abortion and birth statistics both are
essential to provide estimates of pregnancy rates. To assist efforts
to
prevent unintended pregnancy, an accurate assessment of abortion
(including
the number and characteristics of women obtaining legal abortions in
all
states) is needed on an ongoing basis. In 1992, most areas reported
abortions at less than or equal to 8 weeks of gestation by week of
gestation for the first time. This approach to reporting will assist
in
monitoring trends in legal abortions.
     Additional statistical and epidemiologic information about legal
induced abortions is available from CDC's automated Reproductive
Health
Information line at [phone], which provides information by fax,
voice recordings, or mail.

References
1. CDC. Abortion surveillance: preliminary data--United States, 1991.
MMWR
1994;43:42-4.
2. NCHS. Advance report of final natality statistics, 1992.
Hyattsville,
Maryland: US Department of Health and Human Services, Public Health
Service, CDC, 1994. (Monthly vital statistics report; vol 43, no. 5,
suppl).
3. CDC. Abortion surveillance, 1977. Atlanta: US Department of Health
and
Human Services, Public Health Service, 1979.



------------------------------

Date: Wed, 18 Jan 95 06:52:43 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Trends Among Women Who Did Not Receive Prenatal Care
Message-ID: <[e-mail]>

  State-Specific Trends Among Women Who Did Not Receive Prenatal Care -
-
                       United States, 1980-1992

     Lack of prenatal care is strongly associated with an increased
risk

·
for low birthweight (less than 2500 g [less than 5 lbs 8 oz] at birth)
infants, preterm delivery, and maternal and infant mortality (1). From
1980
through 1992, the nationally aggregated percentage of pregnant women
who
did not receive prenatal care increased by 31%--from 1.3% to 1.7%
(2,3).
Because nationally aggregated data can obscure variations among
states, CDC
analyzed state-specific data derived from birth certificates for 1980-
1992
to examine trends among women who did not receive prenatal care. This
report summarizes the findings of the analysis.
     Prenatal-care data were ascertained from the section on the birth
certificate indicating the month of pregnancy in which prenatal care
was
initiated. State-specific percentages for each year from 1980 through
1992
were ordered from lowest to highest to determine the 25th, 50th (i.e.,
median), and 75th percentiles and maximum value for each year. In
addition,
state-specific percentages for women who did not receive prenatal care
were
compared for 1980-1981 and 1991-1992 using the total number of births
to
women who did not receive prenatal care and the total number of
births.
Absolute change was calculated by comparing the percentages for 1980-
1981
with those for 1991-1992.
     From 1980 to 1989, the median state-specific percentage of births
to
women who did not receive prenatal care increased from 0.8% to 1.3%
(Figure
1). Although patterns for the 25th and 75th percentiles were similar,
the
maximum value increased substantially--from 3.7% in 1980 to 7.5% in
1989;
in 1992, the percentage declined to 4.8%. Percentages were
consistently
high in the District of Columbia, Florida, New Mexico, New York, and
Texas.
     For 1980-1981, the percentage of women who did not receive
prenatal
care ranged from 0.14% (Vermont) to 3.67% (New York) (Table 1); for
1991-
1992, the percentages ranged from 0.32% (Utah) to 5.63% (District of
Columbia). When compared with 1980-1981, during 1991-1992 the
percentage
of women who did not receive prenatal care declined in eight states
(Florida, Kentucky, New Jersey, New York, Oklahoma, Rhode Island,
South
Dakota, and Utah) and increased in 42 states and the District of
Columbia;
in nine states, the increase was greater than 100% (Delaware,
Illinois,
Indiana, Louisiana, Michigan, Ohio, Pennsylvania, Vermont, and
Wisconsin).

Reported by: Div of Reproductive Health, National Center for Chronic
Disease Prevention and Health Promotion; Div of Health and Utilization
Analysis, National Center for Health Statistics, CDC.

Editorial Note: Federal and state initiatives during the mid-1980s
aimed
to increase access to prenatal care by expanding Medicaid eligibility
and
increasing funding for maternal and child health block grants and
other
state-funded programs (4,5). The decrease in the percentage of births
to
women who did not receive prenatal care during 1991-1992 is the most
substantial decrease recorded since 1969 (the first year data about
prenatal-care initiation were reported). Despite these improvements,
approximately 69,000 women did not receive prenatal care in 1992.
     Health agencies commonly use aggregated data to describe national
patterns in prenatal care in the United States. However, the findings
in
this and other reports indicate the importance of using state-specific
data
to fully elucidate and better understand long-term trends (6). In
particular, these findings documented substantial variation among
states
for the percentage of women who did not receive prenatal care. For
example,
the comparison of data for 1980-1981 with 1991-1992 demonstrated
slight
decreases in the percentage of women who did not receive prenatal care
in
eight states and substantial increases in nine others.
     The findings in this report are subject to at least two
limitations.
First, the overall increase in the percentage of women who did not
receive
prenatal care may have been related to improved case ascertainment.
From
1980 to 1992, the percentage of women for whom initiation of prenatal
care
was unknown decreased from 2.8% in 1980 to 2.2% in 1992. However, the
increase in the percentage of women who did not receive prenatal care
may
have been related to the decrease in the percentage of women who
initiated
prenatal care during the second trimester (from 18.1% in 1980 to 16.7%
in
1992). The percentages of women who initiated prenatal care during the
first or third trimester remained unchanged (74% and 4%,
respectively).
Second, estimates of the prevalence of nonreceipt of prenatal care may
be
inaccurate because a standard method of measuring initiation of
prenatal
care is not available. Although maternal postpartum interview data (7)
and
birth certificate data identify similar percentages of women who do
not
receive prenatal care, these sources may not identify the same women.
For
example, in a national sample of women who gave birth in 1988, among
those
who were identified either by the birth certificate or maternal
interview
as not receiving prenatal care, only 33% were identified by both
sources
(7).
     Because the importance of prenatal care is widely accepted and
efforts
are made to provide such care to all women, nonreceipt of prenatal
care
should be considered a sentinel health event. A sample of these
episodes
should be investigated to identify and implement interventions. In
particular, public health workers need to determine the reasons for
nonreceipt of prenatal care (e.g., choosing not to obtain care,
inability
to pay for care, or lack of providers or transportation), and state
health
departments should consider the financial, programmatic, and social
factors
that are associated with nonreceipt of prenatal care.

References
1. Office of Technology Assessment, US Congress. Healthy children:
investing in the future. Washington, DC: US Congress, Office of
Technology
Assessment, 1988.
2. NCHS. Vital statistics of the United States, 1980. Vol I, natality.
Washington, DC: US Department of Health and Human Services, Public
Health
Service, 1984; DHHS publication no. (PHS)85-1100.
3. Ventura SJ, Martin JA, Taffel SM, et al. Advance report of final
natality statistics, 1992. Hyattsville, Maryland: US Department of
Health
and Human Services, Public Health Service, CDC, 1994. (Monthly vital
statistics report; vol 43, no. 5, suppl).
4. Singh S, Forrest JD, Torres A. Prenatal care in the United States:
a
state and county inventory. Vols 1 and 2. New York: Alan Guttmacher
Institute, 1989.
5. Committee to Study Outreach for Prenatal Care, National Institute
of
Medicine. Prenatal care: reaching mothers, reaching infants.
Washington,
DC: National Academy Press, 1988.
6. Ingram DD, Makuc D, Kleinman JC. National and state trends in use
of
prenatal care, 1970-83. Am J Public Health 1986;76:415-23.
7. Schoendorf KC, Parker JD, Batkhan LZ, Kiely JL. Comparability of
the
birth certificate and 1988 Maternal and Infant Health Survey.
Hyattsville,
Maryland: US Department of Health and Human Services, Public Health
Service, CDC, NCHS, 1993; DHHS publication no. (PHS)93-1390. (Vital
and
health statistics; series 2, no. 116).



------------------------------

Date: Wed, 18 Jan 95 06:53:37 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: [MMWR] Bolivian Hemorrhagic Fever
Message-ID: <[e-mail]>

       Bolivian Hemorrhagic Fever -- El Beni Department, Bolivia, 1994

     In July 1994, an outbreak of Bolivian hemorrhagic fever (BHF),
which
is caused by Machupo virus, began in northeastern Bolivia. This report
describes the investigation and features of this outbreak, the search
for
additional cases of BHF in El Beni, Bolivia, and results of rodent
investigations.

Initial Investigation
     The outbreak initially occurred among members of an extended
family
residing in Magdalena (1994 population: approximately 5300) located in
the
north central Province of Itenez, El Beni Department (Figure 1). From
July
4 through August 12, 1994, seven family members (aged 10 months-50
years)
developed an illness characterized by fever, hypotension,
subconjunctival
and gingival bleeding, epistaxis, petechiae, tremor, and dysarthria.
Six
of these persons died; the person who had the index case survived.
Laboratory studies performed on serum and tissue specimens from
decedents
confirmed the diagnosis of BHF by isolation of Machupo virus and
detection
of viral antigen in all five patients for whom specimens were
available;
the survivor developed enzyme-linked immunosorbent assay (ELISA)
immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies to
Machupo
virus.

Search for Other Cases
     Following identification of the familial cluster, three
additional
persons in Bolivia with suspected BHF were reported to the National
Secretary of Health through provincial health departments. On August
18,
a broken test tube in a centrifuge exposed a 37-year-old laboratory
technician in Santa Cruz to aerosolized blood from one of the family
members who died. On August 29, the technician developed an acute
febrile
illness with lower back pain, arthralgias, and mild conjunctivitis. On
August 30, intravenous therapy with the antiviral compound ribavirin
was
initiated for a presumptive diagnosis of BHF. She had no hemorrhagic
manifestations and recovered from her illness. Machupo antigen
detection
and virus isolation studies on serum obtained before initiation of
ribavirin treatment were negative, as were IgG and IgM antibody ELISAs
on
serum specimens collected 3 months after onset.
     On August 28, a 41-year-old man residing in Magdalena (with no
known
link to any infected persons) developed an illness that included
fever,
chills, and hip pain. On September 2, he was transferred to a hospital
in
Cochabamba, Bolivia, and died on September 5 following a fulminant
hemorrhagic clinical course. Machupo virus was isolated and viral
antigen
was detected in the patient's serum.
     On September 3, a 52-year-old agricultural worker from Poponas,
El
Beni Department, developed a febrile hemorrhagic illness; on September
11,
he was admitted to a hospital in Trinidad, El Beni Department. On
September
13, intravenous ribavirin therapy was initiated for a presumptive
diagnosis
of BHF, and the patient recovered. The diagnosis of BHF was confirmed
by
detection of viral antigen and virus isolation from the patient's
serum.
     Family members of these three persons with presumptive or
confirmed
BHF cases and health-care workers in contact with these persons were
monitored for febrile illness. However, illness was not noted in these
patient contacts.

Rodent Investigation
     During August and September 1994, rodent trapping was conducted
in
areas of potential exposure for the affected family. During 1811
trap-nights,* 84 rodents were captured, including nine Calomys
callosus.
Testing for antibodies to Machupo virus was negative for each of the
84
rodents. Virus isolation studies on captured rodents are pending.

Reported by: M Villagra, MD, National Hemorrhagic Fever Program,
National
Secretary of Health, Ministry of Human Development; L Suarez, MD,
Regional
Health Secretary, El Beni Department; R Arce, MD, Magdalena Hospital,
Magdalena, Province of Itenez, El Beni Department, Bolivia. MG
Moreira, MD,
Pan American Health Organization, La Paz, Bolivia. Div of Viral and
Rickettsial Diseases, National Center for Infectious Diseases, CDC.

Editorial Note: BHF is a viral hemorrhagic fever known to be endemic
only
in Bolivia; first described in 1959, it caused outbreaks in small
communities in eastern Bolivia throughout the 1960s (1). The etiologic
agent, Machupo virus, is a member of the family Arenaviridae and is
maintained in the rodent C. callosus, the natural reservoir (2). As
with
other arenaviruses, infection of the rodent host results in a
persistent
asymptomatic infection with shedding of virus in urine. Human
infections
are believed to occur following exposure to the virus in aerosolized
rodent
urine. A nosocomial outbreak of BHF in Cochabamba in 1971 suggested
that
person-to-person transmission also may occur by airborne or parenteral
routes (3).
     Following an incubation period of 1-2 weeks, patients infected
with
Machupo virus may develop an influenza-like illness with fever,
malaise,
and fatigue followed by the onset of headache, dizziness, myalgias,
and
severe lower back pain. Prostration, abdominal pain, anorexia,
tremors, and
hemodynamic instability may be followed by hemorrhagic manifestations,
including bleeding from the oral and nasal mucosa and the
gastrointestinal,
genitourinary, and bronchopulmonary tracts (4). BHF can be diagnosed
by
virus isolation from acute serum or tissue specimens or by virus
antigen
detection using an ELISA. Antibodies can be detected using plaque-
reduction
neutralization, indirect immunofluorescence, or ELISAs. Because of the
risk
for laboratory-acquired infections with this highly lethal agent,
tests
with potentially infectious material should be performed in a
biosafety
level 4 laboratory (5).
     Treatment of BHF employs supportive measures. Although
uncontrolled
trials have used convalescent immune plasma from survivors of BHF,
evaluation of the effectiveness of this therapy has been limited by
the
lack of plasmapheresis capability and availability of qualified
donors.
Ribavirin, a broad-spectrum antiviral agent, has been effective
against
human Lassa fever and several arenavirus diseases in animal models.
Patients infected with Junin virus, a closely related arenavirus, also
have
received the drug (6), but there is no definitive evidence concerning
efficacy.
     From 1959 through 1962, Bolivian health officials reported 470
cases
of BHF with 142 deaths (case-fatality rate: 30%) (7). Until the cases
described in this report, the last confirmed outbreak in Bolivia
occurred
in 1971 (3). The mode of transmission of BHF in the familial outbreak
described in this report is unclear. Although no C. callosus were
captured
in the town of Magdalena, a low density of C. callosus was noted in
rural
areas around Magdalena where the index case had worked and traveled.
     Previous trapping in Bolivia has shown fluctuations in population
numbers and prevalence of infection among C. callosus, but the
determining
factors are not known (2,8). Previous cases of BHF occurred following
rodent invasion of households in towns and exposure during campestral
activities, including sleeping in primitive shelters (9). Infection
with
Machupo virus among travelers returning to the United States has not
been
recognized.

References
1. Mackenzie RB, Beye HK, Valverde L, Garron H. Epidemic hemorrhagic
fever
in Bolivia. Am J Trop Med Hyg 1964;13:620-5.
2. Johnson KM, Kuns ML, Mackenzie RB, Webb PA, Yunker CE. Isolation of
Machupo virus from wild rodent Calomys callosus. Am J Trop Med Hyg
1966;15:103-6.
3. Peters CJ, Kuehne RW, Mercado RR, Le Bow RH, Spertzel RO, Webb PA.
Hemorrhagic fever in Cochabamba, Bolivia, 1971. Am J Epidemiol
1974;99:425-
33.
4. Peters CJ. Arenaviruses. In: Belshe RB, ed. Textbook of human
virology.
Littleton, Massachusetts: PSG Publishing Company, Inc, 1984:513-45.
5. CDC. Biosafety in microbiological and biomedical laboratories. 3rd
ed.
Atlanta: US Department of Health and Human Services, Public Health
Service,
CDC, 1993:135-7; DHHS publication no. (CDC)93-8395.
6. Enria DA, Maiztegui JI. Antiviral treatment of Argentine
hemorrhagic
fever. Antiviral Res 1994;23:23-31.
7. Hemorrhagic Fever Commission of Bolivia. Hemorrhagic fever in
Bolivia
[Spanish]. Bulletin of the Panamerican Health Office 1965;58:93-104.
8. Mercado R. Rodent control programmes in areas affected by Bolivian
hemorrhagic fever. Bull World Health Organ 1975;52:691-6.
9. Stinebaugh BJ, Schloeder FX, Johnson KM, Mackenzie RB, Entwisle G,
DeAlba E. Bolivian hemorrhagic fever. Am J Med 1966;40:217-29.


* The total number of traps set in 1 night multiplied by the total
number
of nights during which traps were set.



------------------------------

Date: Wed, 18 Jan 95 06:54:40 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: CancerNet Update for January, 1995
Message-ID: <[e-mail]>

            +----------------------------------------------+
            |       NATIONAL           INSTITUTE           |
            |               C A N C E R                    |
            |  INTERNATIONAL           INFORMATION         |
            |               C E N T E R                    |
            +----------------------------------------------+
                    |  [e-mail]  |
                    +-------------------------------+

CancerNet is now available on the FEDWORLD BBS. You can access
FEDWORLD
via dial-up ( 703 321-8020 8N1) or via the Internet (telnet to:
fedworld.gov
( 192.239.93.3) login: new ). Select Option D (Health Mall) on the
Main menu
and Option B (National Cancer Institute - CancerNet(NCI)).


Changes to CancerNet, January 1995



CancerNet was updated on January 3, 1995.

PDQ Statements
--------------

The following PDQ statements were added or updated in CancerNet with
the
January update (see the file Monthly PDQ Changes -- cn-405001 for
detailed
information on the changes in each statement).


New Statements:

The following treatment statements for physicians were added:

Breast Cancer and Pregnancy                                        cn-
105380
Primary Central Nervous System Lymphoma                            cn-
104272

The following prevention statements were added:

Prevention of Cervical Cancer                                      cn-
304734
Prevention of Ovarian Cancer                                       cn-
305375

Changed Statements:

Changed treatment statements for physicians:

Adult Brain Cancer                                                 cn-
101143
Adult Non-Hodgkin's Lymphoma                                       cn-
100066
Breast Cancer                                                      cn-
100013
Childhood Non-Hodgkin's Lymphoma                                   cn-
100915

Changed treatment statements for patients:

Adult Non-Hodgkin's Lymphoma                                       cn-
200066
Prostate Cancer                                                    cn-
201229


Changed supportive care statements:
None.

Changed screening/prevention statements:
None.


Changed drug information statements:
None.

Changed other PDQ information:
None.


Changed CancerNet News and NCI Publication Information:
-------------------------------------------------------
The following news bulletin was added:

Scientific Committee Makes Recommendation for FTC's Cigarette Test
cn-400076

The following news bulletins were changed:

Group C Protocol Information
cn-400014
FDA's Mammography Quality Standards Act Takes Effect
cn-400075

The following news bulletin was deleted:

Availability of Erwinia L-Asparaginase
cn-400056


There were no changes to the NCI publications.


NCI Fact Sheets
---------------

The following fact sheets were changed:

Waldenstrom's Macroglobulinemia                                     cn-
600064
Financial Assistance for Cancer Care                                cn-
600083
Referral Information for the BCPT  complete list                    cn-
400021
BCPT Referral (partial list  - Hawaii to Michigan                   cn-
400023
BCPT Referral (partial list  - North Dakota to Texas                cn-
400025
Referral Information for the PCPT (complete list)                   cn-
400090
PCPT Referral (partial list) - Alabama to Georgia                   cn-
400091
PCPT Referral (partial list) - Illinois to Michigan                 cn-
400092
PCPT Referral (partial list) - Minnesota to North Carolina          cn-
400093


CANCERLIT Citations and Abstracts:
----------------------------------

No new CANCERLIT citation and abstract topics were added.


The CANCERLIT citations and abstracts for January will be available on

·
on January 6, 1994. Replace the __ with the two digit month
code when requesting CANCERLIT citation and abstract topics from the
CancerNet mail server.


Instructions:

To request the CancerNet Instructions and Contents List, send a
mail message, and in the body of the message,  enter HELP.  Address
the mail message to:

          [e-mail]

To request the modified statements, follow the above directions,
and in the body of the mail message, enter the statement code.
When requesting more than one statement, enter each code on a
separate line.

CancerNet statements are now available in Spanish. To request the
Instructions and Contents List in Spanish, enter SPANISH in the
body of the mail message. If you would like to request the statements
in Spanish, substitute the prefix "cs-" in front of the number
(e.g., cs-100022) to receive the statement on anal cancer in Spanish .
All of the physician and patient statements are available in Spanish.
Supportive care statements are now available in Spanish.
News items that are available in Spanish have a # next to the
statement
title. Although both the English and Spanish are updated at the same
time each month, the Spanish statements do not reflect the changes
made
in the English statements until the following month to allow time for
translation . If you are interested in requesting CancerNet statements
or news articles in Spanish, it is suggested that you request an
updated
Contents List.

If you are redistributing the PDQ information you retrieve from
CancerNet to others at your location, or are interested in
redistributing
the information from CancerNet, request the news article,
Redistribution
of Cancernet (cn-400030) , to find out about conditions that apply
when
redistributing the information.  This article also has information on
other sites providing access to CancerNet information.

Please send comments or questions to:

Cheryl Burg
NCI International Cancer Information Center
Internet: [e-mail]



------------------------------

Date: Wed, 18 Jan 95 06:55:38 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: Q&A About AIDS Saliva Test
Message-ID: <[e-mail]>

     Centers for Disease Control and Prevention
     National Center for Infectious Diseases
     Division of HIV/AIDS
     Atlanta, GA
     December 1994


        Questions and Answers about the Saliva HIV Antibody Test


     1Q.  What is this new test using saliva?

     1A.  The Food and Drug Administration (FDA) has approved a
     device to collect oral fluid for use with a laboratory test to
     detect antibody to HIV.  This assay uses a special
     collection device to obtain a specimen of saliva which is
     then tested for HIV antibody.  The device resembles an
     ordinary cotton swab in appearance.  No needles or skin
     puncturing are required.


     2Q.  Is this test as good as the blood tests that have been in
     use for years?

     2A.  Since confirmatory tests are not yet licensed for saliva,
     any individual whose saliva tests reactive will still have
     to have their blood drawn for follow-up testing.  Positive
     results will continue to require blood testing for HIV
     antibody.  CDC studies show that the sensitivity of a
     correctly used saliva HIV antibody test is acceptable for
     use in public health and clinical settings where follow up
     serologic testing is in place.


     3Q.  If you can do an HIV antibody test on saliva, then why isn't
     HIV transmitted by kissing?

     3A.  This test detects HIV antibody which is a protein present
     in saliva, even when HIV itself is not present in saliva.
     Previous studies have shown that low levels of HIV can be
     found in saliva especially when visible blood is present.
     Although studies have not shown HIV transmission via contact
     with saliva, the Public Health Service advises against deep
     kissing with known infected persons because of a theoretical
     risk of transmission.


     4Q.  Who will be able to use this test?

     4A.  The device will be sold to physicians who may train non-
     medical persons to collect clinical specimens to evaluate
     patients who consent to it.  Specimens must be processed in
     a laboratory as blood specimens currently are.  This is not
     a "home test kit."


     5Q.  How should this test be used?

     5A.  Persons who are tested for HIV antibody with this saliva
     test should be given the same considerations as with any HIV
     test.  They should consent to be tested and receive
     appropriate pre and post test counseling.  All test results
     should be kept confidential.


     6Q.  What counseling message should be provided to clients that
     have a reactive HIV-1 saliva test?

     6A.  Clients who wish to be tested with the saliva HIV-1 test
     should be counseled during the informed consent session
     about the meanings of any possible reactive results.  Risk
     behavior assessment and discussion about change in any risky
     behaviors are critical parts of the counseling process.
     Persons who receive a reactive saliva result should abstain
     from sex (or use condoms if unable to abstain) and needle
     use and not donate blood or tissue until results have been
     confirmed with the use of routine HIV antibody blood tests,
     e.g., ELISA and Western blot.  Follow-up counseling should
     include the elements of appropriate medical and psychosocial
     referrals.


     7Q.  How much will a test cost?  Will it be less than a blood
     test?

     7A.  Prices will be set by the test kit's manufacturer, the
     laboratory that performs the test, and the clinician who
     collects the specimen or orders the test.  As with other
     medical tests, prices are likely to vary widely.



------------------------------

Date: Wed, 18 Jan 95 06:57:02 MST
From: [e-mail] (HICNet Medical News)
To: hicnews
Subject: Clinical Alert - Ischemic Optic Neuropathy Decompression
Trial
Findings
Message-ID: <[e-mail]>

Clinical Alert: National Eye Institute Announces Ischemic
Optic Neuropathy Decompression Trial (IONDT) Findings.

Abstract: The IONDT compared the safety and efficacy of
optic nerve decompression surgery plus careful followup
versus careful followup alone in patients with non-arteric
ischemic optic neuropathy (NAION).  Preliminary results
indicate that decompression surgery was no better than
careful followup, based on a detailed statistical analysis.
It is concluded that optic nerve decompression surgery is
not an appropriate treatment for NAION.

The following is the text of a letter, dated January 3,
1995, sent to ophthalmologists and neurologists, and signed
by Dr. Carl Kupfer, Dr. Shalom Kelman, and Dr. Kay
Dickersin.

Dear Colleague:

This letter is to inform you of findings from the
Ischemic Optic Neuropathy Decompression Trial (IONDT) that
warrant your attention prior to publication of the results.
This randomized, controlled clinical trial is supported by
the National Eye Institute (NEI), part of the National
Institutes of Health, and is being conducted at 25 clinical
centers nationwide (see attached list of study sites).  The
study is headquartered at the University of Maryland at
Baltimore.

The IONDT compared the safety and efficacy of optic
nerve decompression surgery plus careful followup versus
careful followup alone in patients with non-arteritic
ischemic optic neuropathy (NAION).

All patients were diagnosed with NAION by IONDT neuro-
ophthalmologists.  In the study, decompression surgery was
standardized, and each physician's surgical ability was
reviewed by the IONDT's Surgical Quality Assurance
Committee.  Moreover, all surgeons were required to have
previously performed ten or more decompression operations to
be certified to participate in the study.

As of September, 1994, the study had received and
analyzed outcome data from 244 patients.  Of these patients,
119 had been randomized to decompression surgery and 125 to
careful followup, with 95 and 91, respectively, having
completed six months of followup.

Preliminary results indicate that decompression surgery
was no better than careful followup, based on a detailed
statistical analysis.  These results include:

o    At six months of followup, 43 percent of careful
followup patients improved three or more lines of vision
(using the New York Lighthouse chart).  In the surgery
group, 33 percent had a three-line improvement in their
vision over the same followup period.  Thus, surgery has no
positive effect on outcome compared to careful followup.

o    Twelve percent of eyes in careful followup lost three
or more lines of vision at six months, compared to 24
percent in the surgical group.  This suggests that
decompression surgery may be harmful.

o    The IONDT's finding that 43 percent of careful followup
patients had spontaneous improvement of three or more lines
in their vision (See Bullet 1) is much higher than
previously reported.  Most of the earlier studies had
indicated a spontaneous improvement rate of ten percent or
less.

o    No beneficial surgical effect on visual acuity was seen
in patients with progressive visual loss.

In late October 1994, the IONDT's Data and Safety
Monitoring Committee reviewed these preliminary findings and
recommended that recruitment to the IONDT cease with
enrolled patients continuing to be followed.  Thereafter,
the NEI halted patient recruitment, and study investigators
reviewed the data.  A scientific paper was submitted to the
Journal of the American Medical Association for expedited
review in mid-November, was accepted, and will be published
in an upcoming issue of the Journal.

Based on the above results, we conclude that optic nerve
decompression surgery is not an appropriate treatment for
NAION.  We can offer no recommendation regarding the safety
and efficacy of this surgery for other conditions.

            Sincerely,


            Carl Kupfer, M.D.
            Director
            National Eye Institute


            Shalom Kelman, M.D.
            IONDT Chairman
            University of Maryland at Baltimore
            School of Medicine


            Kay Dickersin, Ph.D.
            Director, IONDT Coordinating Center
            University of Maryland at Baltimore
            School of Medicine


ISCHEMIC OPTIC NEUROPATHY DECOMPRESSION TRIAL
Participants List

            California
            Steven Feldon, M.D.
            Doheny Eye Institute
            University of Southern California
            1450 San Pablo Street
            Los Angeles, California 90033-
            4683
            Telephone: [phone]

            Anthony Arnold, M.D.
            Jules Stein Eye Institute
            100 Stein Plaza, UCLA
            Los Angeles, California
            90024-7005
            Telephone: [phone]

            Jonathan Horton, M.D.
            Department of Ophthalmology
            University of California, San
            Francisco
            Eight Kirkham Street
            San Francisco, California
            94143-0644
            Telephone: [phone]

            Florida
            John R. Guy, M.D.
            Department of Ophthalmology
            University of Florida
            Box 100-284, JHMHC
            Gainesville, Florida 32610-0284
            Telephone: [phone]

            Georgia
            Nancy J. Newman, M.D.
            Emory Eye Center
            Emory University
            1327 Clifton Road, N.E.
            Atlanta, Georgia 30322
            Telephone: [phone]

            Illinois
            James A. Goodwin, M.D.
            Department of Ophthalmology
            University of Illinois
            1855 West Taylor Street
            Chicago, Illinois 60612
            Telephone: [phone]

            Kentucky
            Robert S. Baker, M.D.
            Department of Ophthalmology
            University of Kentucky
            Room E304 Kentucky Clinic
            801 Rose Street
            Lexington, Kentucky 40536-0284
            Telephone: [phone]

            Maryland
            Shalom E. Kelman, M.D.
            Professional Building
            University of Maryland
            419 West Redwood Street
            Suite 420
            Baltimore, Maryland 21201
            Telephone: [phone]

            Michigan
            Wayne Cornblath, M.D.
            W. K. Kellogg Eye Center
            University of Michigan
            1000 Wall Street
            Ann Arbor, Michigan 48105
            Telephone: [phone]

            Barry Skarf, M.D.
            Henry Ford Hospital
            Department of Ophthalmology
            K-10
            2799 West Grand Boulevard
            Detroit, Michigan 48202
            Telephone: [phone]

            David I. Kaufman, D.O.
            Department of Ophthalmology
            Michigan State University
            Unit for Neuro-visual Disorders
            A217 Clinical Center
            138 Service Road
            East Lansing, Michigan 48824
            Telephone: [phone]

            Edward Cohn, M.D.
            William Beaumont Eye Institute
            William Beaumont Hospital
            3535 West Thirteen Mile
            Suite 506
            Royal Oak, Michigan 48073
            Telephone: [phone]

            Minnesota
            Brian R. Younge, M.D.
            Mayo Clinic, E-7A Mayo Building
            200 First Street, S.W.
            Rochester, Minnesota 55905
            Telephone: [phone]

            Missouri
            Lenworth Johnson, M.D.
            Mason Eye Institute
            University of Missouri - Columbia
            One Hospital Drive
            Columbia, Missouri 65212
            Telephone: [phone]

            Sophia M. Chung, M.D.
            Anheuser-Busch Eye Institute
            1755 South Grand Boulevard
            St. Louis, Missouri 63104
            Telephone: [phone]

            New York
            Deborah Friedman, M.D.
            SUNY Health Science Center
            750 East Adams Street
            Syracuse, New York 13210
            Telephone: [phone]

            North Carolina
            Mark Malton, M.D.
            Carolinas Medical Center
            2015 Randolph Road, Suite 108

·
(continued next message)


 @FROM   :[e-mail]
· (Continued from last message)
            Charlotte, North Carolina 28207
            Telephone: [phone]

            Ohio
            Gregory Kosmorsky, D.O.
            The Cleveland Clinic Foundation
            Desk A 31/Ophthalmology
            9500 Euclid Avenue
            Cleveland, Ohio 44195
            Telephone: [phone]

            Pennsylvania
            John Kennerdell, M.D.
            Allegheny General Hospital
            420 East North Avenue, Suite 116
            Pittsburgh, Pennsylvania 15212
            Telephone: [phone]

            South Carolina
            Mitchell J. Wolin, M.D.
            University of South Carolina
            Department of Ophthalmology
            #4 Richland Medical Park, Suite
            100
            Columbia, South Carolina 29203
            Telephone: [phone]

            Texas
            Rosa A. Tang, M.D.
            University of Texas
            2476 Bolsover, #359
            Houston, Texas 77005
            Telephone: [phone],

            Utah
            Kathleen A. Digre, M.D.
            University of Utah
            Department of Ophthalmology
            50 North Medical Drive
            Salt Lake City, Utah 84132
            Telephone: [phone]

            Virginia
            Steven A. Newman, M.D.
            University of Virginia
            Department of Ophthalmology
            Box 475
            Charlottesville, Virginia 22908
            Telephone: [phone]

            Warren L. Felton III, M.D.
            Department of Neurology
            Division of Neuro-ophthalmology
            Medical College of Virginia
            Box 980599
            Richmond, Virginia 23298-0599
            Telephone: [phone]

            West Virginia
            John Linberg, M.D.
            West Virginia University
            Department of Ophthalmology
            P.O. Box 9193
            Morgantown, West Virginia 26506
            Telephone: [phone]

RESOURCE CENTERS

            Chairman's Office
            Shalom E. Kelman, M.D.
            Professional Building
            University of Maryland
            419 West Redwood Street
            Suite 460
            Baltimore, Maryland 21201
            Telephone: [phone]

            Coordinating Center
            Kay Dickersin, Ph.D.
            Department of Epidemiology &
               Preventive Medicine
            University of Maryland
            228 Howard Hall
            660 West Redwood Street
            Baltimore, Maryland 21201
            Telephone: [phone]



------------------------------

End of HICNet Medical News Digest V08 Issue #03
***********************************************


---
Editor, HICNet Medical Newsletter
Internet: [e-mail]                 FAX: [phone]
Bitnet  : ATW1H@ASUACAD