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HICNet Medical News Digest Mon, 23 May 1994 Volume 07 : Issue 21
Today's Topics:
[MMWR 20 May 1994] Role of Media in Tobacco Control
[MMWR] Cigarette Smoking Among Adults
[MMWR] HIV Transmission in Household Settings
[MMWR] Tornado Disaster
FDA Reviews Antihistamine Mouse Study
Institute of Tropical Medicine Epidemiological Bulletin
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! Health Info-Com Network !
! Medical Newsletter !
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Editor: David Dodell, D.M.D.
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Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden
Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA
Lawrence Lee Miller, B.S. Biological Sciences, UCI
Dr K C Lun, National University Hospital, Singapore
W. Scott Erdley, MS, RN, SUNY@UB School of Nursing
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Date: Sun, 22 May 94 22:34:46 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR 20 May 1994] Role of Media in Tobacco Control
Message-ID: <N1JRmc1w165w@stat.com>
Role of Media in Tobacco Control --
World No-Tobacco Day, 1994
The mass media have played an important role in efforts to control and
prevent tobacco use. To recognize the effectiveness of these efforts, the
theme of the seventh World No-Tobacco Day, to be held May 31, 1994, is "The
Media and Tobacco: Getting the Health Message Across." Activities will
include press releases, videotape presentations, educational symposia, and
radio announcements by World Health Organization experts on tobacco
control.
The need for collaboration between public health workers and media
representatives is particularly urgent in developing countries in which the
prevalence of tobacco use is increasing. In these countries, the
dissemination of information through the media also can assist in the
development of educational and legislative measures to prevent and control
tobacco use (1,2) and may help reduce the success of aggressive marketing
campaigns by transnational tobacco companies. Examples of collaboration
between the media and the tobacco-control groups in some countries include
successful smoking-cessation and health-education campaigns (e.g., in
Estonia, Finland, and New Guinea) and decisions by certain media to refuse
cigarette advertising (e.g., in Australia, Canada, and the United States).
Additional information about World No-Tobacco Day 1994 is available
from the Office of Information and Public Affairs, Pan American Health
Organization (telephone [202] 861-3458) or from CDC's Office on Smoking and
Health, National Center for Chronic Disease Prevention and Health Promotion
(telephone [404] 488-5705).
References
1. World Health Organization. World No-Tobacco Day--31 May 1994 [Advisory
kit]. Geneva: World Health Organization, 1994.
2. National Cancer Institute. Strategies to control tobacco use in the
United States: a blueprint for public health action in the 1990's.
Bethesda, Maryland: US Department of Health and Human Services, Public
Health Service, National Institutes of Health, 1991; DHHS publication no.
(NIH)92-3316.
------------------------------
Date: Sun, 22 May 94 22:35:33 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Cigarette Smoking Among Adults
Message-ID: <y2JRmc2w165w@stat.com>
Cigarette Smoking Among Adults --
United States, 1992, and Changes in the Definition
of Current Cigarette Smoking
Use of tobacco in the United States is monitored continually by CDC to
evaluate efforts to control and prevent the use of this substance. The
prevalence of cigarette smoking among U.S. adults decreased from 1965 to
1990 (from 42.4% to 25.5%) and remained stable from 1990 to 1991 (from
25.5% to 25.6%) (1). To determine the prevalence of smoking among adults
during 1992, the National Health Interview Survey-Cancer Control and
Epidemiology Supplements (NHIS-CCES) collected self-reported information on
cigarette smoking from a random sample of civilian, noninstitutionalized
adults aged greater than or equal to 18 years. For 1992, the definition
used to assess self-reported smoking prevalence was changed to more
accurately assess some-day (i.e., intermittent) smoking because of a
recognized higher prevalence of intermittent smoking (2). This report
presents the prevalence estimates for 1992, compares findings with 1991,
and assesses the impact of changes in the definition of current smoker on
these estimates.
The overall response rate for the 1992 NHIS-CCES (n=24,040) was 86.5%.
For 1992, two nationally representative random samples from the NHIS-CCES
were used to assess the new definition of current smoking status that
included intermittent smoking. The Cancer Control Supplement (CCS)
(n=12,035) asked, "Have you smoked at least 100 cigarettes in your entire
life?" and "Do you smoke cigarettes now?" Persons who said they did not
smoke now were asked, "Do you now smoke cigarettes not at all or some
days?" Current smokers were defined as those who had smoked 100 cigarettes
and smoked now; persons who said they did not smoke now but subsequently
stated they smoked on some days were also classified as current smokers.
The Cancer Epidemiology Supplement (CES) (n=12,005) asked, "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?" Current smokers were
defined as those who had smoked 100 cigarettes and now smoked either every
day or some days. 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).
Because the first two questions were the same for the 1991 NHIS-Health
Promotion and Disease Prevention supplement and the 1992 CCS, these
findings were compared directly. The overall prevalence of cigarette
smoking among adults (25.6%) was the same in 1991 and 1992 (Table 1). The
1992 estimates that incorporated some-day smoking (CCS and CES) also were
compared with 1991 and 1992 estimates based on the original definition.
Estimates for both sets of definitions that incorporated an assessment of
some-day smoking in 1992 were similar (CCS=26.7% and CES=26.3%) (Table 1).
Because of the comparability of methods (i.e., assessing some-day smoking),
results were combined to provide an overall prevalence estimate for 1992.
Based on the inclusion of intermittent smoking, the prevalence of smoking
increased by 0.9% (from 25.6% to 26.5%) (Table 1).
In 1992, an estimated 48 million (26.5% [95% CI=plus or minus 0.5%])
adults in the United States were current smokers, reflecting prevalences of
daily smoking of 22.1% (95% CI=plus or minus 0.5%) and some-day smoking of
4.4% (95% CI=plus or minus 0.2%). Smoking prevalence was highest among
persons aged 25-44 years (30.8% [95% CI=plus or minus 0.8%]). Smoking
prevalence was highest among American Indians/Alaskan Natives (39.4% [95%
CI=plus or minus 6.0%]) and lowest among Asians/Pacific Islanders (15.2%
[95% CI= plus or minus 3.6%]), declined with increasing levels of
education, and was highest among persons who lived below the poverty level*
(34.9% [95% CI=plus or minus 1.5%]). Approximately 25 million men (28.6%
[95% CI=plus or minus 0.8%]) and 23 million women (24.6% [95% CI=plus or
minus 0.7%]) were current smokers (Table 2). For most demographic groups,
smoking prevalence was higher among men than women.
Using the original definition of current smoking, smoking prevalence
was the same in 1991 and 1992 overall, for both men and women, for all
racial/ethnic groups, for all educational levels, and for persons with
incomes above the poverty level (Table 1). Smoking prevalence was
significantly higher in 1992 (37.0% [95% CI= plus or minus 2.1%]) than in
1991 (33.1% [95% CI=plus or minus 1.5%]) among persons living below the
poverty level. However, among persons with incomes below the poverty level,
there were substantial differences in smoking prevalence as measured by the
two question formats that included some-day smokers. As a result, the
combined prevalence estimate for 1992 was not significantly different from
the 1991 estimate.
Reported by: Surveillance Program, National Cancer Institute. National
Institutes of Health. Epidemiology Br, Office on Smoking and Health,
National Center for Chronic Disease Prevention and Health Promotion; Div of
Health Interview Statistics, National Center for Health Statistics, CDC.
Editorial Note: The findings in this report indicate that the estimated
prevalence of smoking in 1992 was the same as in 1991 overall and for most
demographic groups. In addition, these findings indicate that including
some-day smoking in the definition of current smoking will increase the
prevalence estimate by approximately 1.0%. The definition used in the 1992
CES will become the standard for CDC efforts to measure smoking prevalence
in the United States. The inclusion of intermittent smoking improves both
the accuracy and precision of the definition of current smoking and
facilitates efforts to monitor changes in current smoking status.
Based on use of the original definition of current smoker, which did
not assess some-day smoking, the prevalence of smoking in 1992 was
significantly higher than in 1991 among persons living below the poverty
level. This finding was attributable to a substantial increase in the
prevalence of smoking among women who live below the poverty level and to a
smaller increase among men. The impact of changes in the question format
that incorporated an assessment of some-day smoking substantially altered
the prevalence estimates for persons living below the poverty level.
Specifically, in the CCS survey--which used a two-part question to assess
some-day smoking--smoking prevalence increased among persons living below
the poverty level. In comparison, in the CES survey--which used a single
question to assess some-day smoking--there was no change in smoking
prevalence.
For the first time since 1983, smoking prevalence among persons aged
18-24 years did not decrease. Factors that may have contributed to the
stabilization include the steady growth in market share of discount
cigarettes (4) and the $4.6 billion in advertising and promotional
expenditures by tobacco companies during 1991--a 16% increase in
expenditures when compared with 1990 (5,6). Efforts to address smoking
among young persons have included the 1994 Surgeon General's report (6) and
a companion report for adolescents. In addition, CDC has published school
guidelines for incorporating tobacco-use prevention and tobacco-cessation
strategies (7).
The findings in this report are subject to at least two limitations.
First, the prevalence estimate for 1992 was based on information collected
from January through July 1992. In comparison, a different survey that
collected data for the entire year indicated that smoking prevalence among
adults declined in the second half of the year (Substance Abuse and Mental
Health Services Administration, unpublished data, 1992), a finding
consistent with a 3% per capita decrease in consumption of cigarettes in
1992 (8). Second, differences in prevalence among racial/ethnic groups may
be influenced by differences in educational levels and socioeconomic
status, as well as by social and cultural phenomena that require further
explanation.
Acceleration of the decline in smoking prevalence will require
intensified efforts to discourage the use of tobacco by helping smokers
break the addiction to nicotine, persuading children to never initiate
smoking, and enacting public policies that discourage smoking. Examples of
such policies include increasing taxes on tobacco products, enforcing
minors'-access laws, restricting smoking in public places, and restricting
tobacco advertising and promotion. In January 1994, for the first time, all
50 states and the District of Columbia were receiving public funds for
tobacco-control activities: 49 states and the District of Columbia were
receiving federal funds, and California was receiving state funds.
References
1. NCHS. Health, United States, 1992. Hyattsville, Maryland: US Department
of Health and Human Services, Public Health Service, CDC, 1993.
2. Evans NJ, Gilpin E, Pierce JP, et al. Occasional smoking among adults:
evidence from the California Tobacco Survey. Tobacco Control 1992;1:169-75.
3. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.50
[Software documentation]. Research Triangle Park, North Carolina: Research
Triangle Institute, 1991.
4. Maxwell JC Jr. The Maxwell consumer report: 1992 year-end and
fourth-quarter sales estimates for the cigarette industry. Richmond,
Virginia: Butcher and Singer, February 10, 1993; publication no. WFBS-6983.
5. US Federal Trade Commission. Federal Trade Commission report to Congress
for 1991: pursuant to the Federal Cigarette Labeling and Advertising Act.
Washington, DC: US Federal Trade Commission, 1994.
6. US Department of Health and Human Services. Preventing tobacco use among
young people: a report of the Surgeon General. Atlanta: US Department of
Health and Human Services, Public Health Service, CDC, National Center for
Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health, 1994.
7. CDC. Guidelines for school health programs to prevent tobacco use and
addiction. MMWR 1994;43(no. RR-2).
8. US Department of Agriculture. Tobacco situation and outlook report.
Washington, DC: US Department of Agriculture, Economic Research Service,
Commodity Economics Division, April 1994; publication no. TBS-226.
* Poverty statistics are based on definitions 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: Sun, 22 May 94 22:36:33 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] HIV Transmission in Household Settings
Message-ID: <m4JRmc3w165w@stat.com>
Human Immunodeficiency Virus Transmission
in Household Settings -- United States
Transmission of human immunodeficiency virus (HIV) has been reported
in homes in which health care has been provided and between children
residing in the same household (1-6). CDC has received reports of two cases
of HIV infection that apparently occurred following mucocutaneous exposures
to blood or other body substances in persons who received care from or
provided care to HIV-infected family members residing in the same
household. This report summarizes the findings of the epidemiologic and
laboratory investigations, which underscore the need to educate persons who
care for or are in contact with HIV-infected persons in household settings
where such exposures may occur.*
Patient 1
A 5-year-old child whose parents were both HIV-infected tested
negative for HIV antibody in 1990 and July 1993 but tested positive in
December 1993. In February 1994, all other close household contacts of the
child tested HIV-antibody negative.
From January through December 1993, when the child was likely to have
become infected, the child's parents were the only known HIV-infected
persons with whom the child had any contact. During this period, the child
lived with both parents until the father's death as the result of acquired
immunodeficiency syndrome (AIDS) in May 1993. The child continued to live
with the mother, who had AIDS, until 8 days before the child's last
negative antibody test in July 1993. The child then lived in foster care.
The child had several opportunities for contact with HIV-infected
blood and exudative skin lesions. Based on the mother's medical records and
history, from March through August 1993 the mother had recurrent, purulent,
exudative skin lesions (diagnosed as prurigo nodularis) on her face, neck,
torso, buttocks, and extremities. She frequently scratched the lesions
until they bled, left the lesions uncovered, and discarded onto the
furniture or the floor the gauze and tissues used to wipe the exudate.
During periods when the mother's skin lesions were uncovered and draining,
the child frequently hugged and slept with the mother. In addition, the
child intermittently had scabs from impetigo and abrasions that the mother
sometimes picked off and caused to bleed. When the mother had intermittent
gingival bleeding, she periodically shared a toothbrush with the child.
From January through May 1993, the child had no known contact with the
father's blood or body fluids, although the child sometimes used his
toothbrush.
No other situations were identified in which the child potentially may
have been exposed to HIV-infected blood or had contact with an HIV-infected
person. There were no known HIV-infected persons in either the foster home
or the school, and the child had no known contact with blood in these
settings. Based on interviews and medical record reviews, no household
members at either the parents' home or foster home engaged in
injecting-drug use. Based on history and physical examination, sexual abuse
of the child was believed to be unlikely. During 1993, the child had no
injections, blood transfusions, vaccinations, or invasive dental or medical
procedures.
Proviral DNA from peripheral blood mononuclear cells obtained from the
mother and the child was amplified by polymerase chain reaction. By direct
sequencing, the two DNA fragments encompassing 343 nucleotides of the V3
and flanking regions of the gene encoding the HIV-1 envelope glycoprotein
(gp120) were genetically similar, differing by only 2.6%. No specimen was
available from the child's father.
Patient 2
In August 1991, a 75-year-old woman was evaluated because of fatigue
and malaise and tested positive for HIV antibody; her adult son died in
August 1990 as the result of AIDS. Her CD4+ T-lymphocyte count was 837
cells/uL. She had been married for approximately 50 years; her husband
tested negative for HIV antibody. The patient reported no other sex
partners and denied all risk factors for HIV infection, including
injecting-drug use and receipt of blood or blood products since 1978; she
had not been employed in a health-care setting. The woman had a
cholecystectomy in December 1990; in February 1992, all members of the
surgical team tested negative for HIV antibody.
Her son had lived in the household from September 1989 until his
death. He initially was able to care for himself; however, in July 1990 (6
weeks before his death), his mother began to provide daily nursing care for
him (e.g., bathing, feeding, changing diapers, and repositioning his
urinary catheter). Although she had been informed of the need to wear
gloves while providing such care, she reported inconsistent adherence to
this recommendation. She could not recall any direct exposures to her son's
blood. Her son did not require intravenous fluids or medication in the home
nor did he have an intravascular device. No needles or other sharp
instruments related to his care were in the home. Dermatologic conditions
had not been noted.
The son had hemorrhoids and diarrhea, but neither visible blood nor
melena had been noticed at home. The mother reported skin contact with her
son's feces on at least one occasion. While hospitalized in February 1990,
he had upper gastrointestinal bleeding; endoscopy revealed chronic
gastritis and duodenitis. During hospitalization in June 1990, he had an
episode of lower gastrointestinal bleeding. No such bleeding episodes
occurred at home.
The son had poor dentition and gingivitis around his upper molars, and
his mother frequently handled the cotton-tipped swabs her son used for his
oral hygiene care, although she attempted to avoid touching the cotton tips
with bare hands. She reported having infrequent small cuts on her hands but
had no history of dermatitis or other skin lesions. There were no blood
specimens available from the son for HIV DNA sequencing.
Reported by: Div of HIV/AIDS and Hospital Infections Program,
National Center for Infectious Diseases, CDC.
Editorial Note: The findings of the investigations described in this report
indicate the transmission of HIV as the result of contact with blood or
other body secretions or excretions from an HIV-infected person in the
household. In both instances, exposures occurred after the source-patients
had developed AIDS; consequently, relatively high HIV titers may have been
present in their blood.
For patient 1, who had had direct exposure to purulent and bloody
exudates from the mother's open skin lesions, transmission may have been
facilitated by the child's broken skin and the mother's manipulation of the
child's skin lesions. Patient 2 most likely became infected while providing
nursing care for her son. Although the precise mode of transmission is
unknown, she had direct contact with her son's urine and feces; because of
his chronic gastritis and duodenitis, some blood could have been present in
his feces, even though the blood was inapparent to his mother. In addition,
she could have had other unrecognized or unrecalled exposures to her son's
blood.
Even though previous reports have documented HIV transmission as the
result of skin or mucous-membrane exposure to HIV-infected blood, HIV is
not easily transmitted by this route. Based on assessment of health-care
workers exposed to HIV-infected blood, the risk for HIV transmission has
been estimated to be less than 0.1% for a single mucous-membrane exposure
(95% confidence interval=0.006-0.50) (7). The risk is probably lower for
skin exposures to HIV-infected blood and even lower, if present at all, for
skin exposures to body secretions and excretions without visible blood
(7,8). Although previous reports document that HIV has been isolated from
urine (9) and that HIV nucleic acid--but not infectious HIV--has been
detected in feces (10), transmission of HIV by urine or feces has not been
reported.
Although contact with blood and other body substances can occur in
households, transmission of HIV is rare in this setting. In addition to the
two patients in this report, six previous reports have described household
transmission of HIV not associated with sexual contact, injecting-drug use,
or breast feeding (Table 1). Of these eight reports, five were associated
with documented or probable blood contact ([1,3-5] and patient 1 in this
report). In the sixth report, HIV infection was diagnosed in a boy after
his younger brother had died as the result of AIDS; however, a specific
mechanism of transmission was not determined (6). Two reports involved
nursing care of terminally ill persons with AIDS in which a blood exposure
might have occurred but was not documented ([2] and patient 2 in this
report); in both reports, skin contact with body secretions and excretions
occurred.
Persons who provide nursing care for HIV-infected patients in home
settings should employ precautions to reduce exposures to blood and other
body fluids (11). In particular, needles and sharp objects contaminated
with blood should be handled with care. Needles should not be recapped by
hand or removed from syringes. Needles and sharp objects should be disposed
of in puncture-proof containers, and the containers should be kept out of
reach of children and visitors. Bandages should be used to cover cuts,
sores, or breaks on exposed skin of persons with HIV infection and of
persons providing care. In addition, persons who provide such care should
wear gloves when there is a possibility of direct contact with HIV-infected
blood or other body fluids, secretions, or excretions. Because urine and
feces may contain a variety of pathogens, including HIV, persons providing
nursing care to HIV-infected persons should wear gloves during contact with
these substances. In addition, even when gloves are worn, hands should be
washed after contact with blood and other body fluids, secretions, or
excretions.
Because of the social, economic, and medical benefits of home care,
the number of persons with AIDS who receive health care outside of
hospitals is increasing. Persons infected with HIV and persons providing
home care for those who are HIV-infected should be fully educated and
trained regarding appropriate infection-control techniques. In addition,
health-care providers should be aware of the potential for HIV transmission
in the home and should provide training and education in infection control
for HIV-infected persons and those who live with or provide care to them in
the home. Such training should be an integral and ongoing part of the
health-care plan for every person with HIV infection.
Additional infection-control recommendations are contained in a
recently updated brochure published by CDC, Caring for Someone with AIDS:
Information for Friends, Relatives, Household Members, and Others Who Care
for a Person With AIDS at Home. This brochure is available free in English
or Spanish from the CDC National AIDS Clearinghouse, P.O. Box 6003,
Rockville, MD 20849-6003; telephone (800) 458-5231 or (301) 217-0023.
References
1. CDC. Apparent transmission of human T-lymphotrophic virus type
III/lymphadenopathy-associated virus from a child to a mother providing
health care. MMWR 1986;35:76-9.
2. Grint P, McEvoy M. Two associated cases of the acquired immunodeficiency
syndrome (AIDS). Communicable Disease Report 1985;42:4.
3. CDC. HIV infection in two brothers receiving intravenous therapy for
hemophilia. MMWR 1992;41:228-31.
4. Fitzgibbon JE, Gaur S, Frenkel LD, et al. Transmission from one child to
another of human immunodeficiency virus type 1 with a zidovudine-resistance
mutation. N Engl J Med 1993;329: 1835-41.
5. CDC. HIV transmission between two adolescent brothers with hemophilia.
MMWR 1993;42:948-51.
6. Wahn V, Kramer HH, Voit T, Bruster HT, Scrampical B, Scheid A.
Horizontal transmission of HIV infection between two siblings [Letter].
Lancet 1986;2:694.
7. Ippolito G, Puro V, De Carli G, Italian Study Group on Occupational Risk
of HIV Infection. The risk of occupational human immunodeficiency virus
infection in health care workers: Italian Multicenter Study. Arch Intern
Med 1993;153:1451-8.
8. Henderson DK, Fahey BJ, Willy M, et al. Risk for occupational
transmission of human immunodeficiency virus type 1 (HIV-1) associated with
clinical exposures: a prospective evaluation. Ann Intern Med
1990;113:740-6.
9. Levy JA. Pathogenesis of human immunodeficiency virus infection.
Microbiol Rev 1993;57:183-289.
10. Yolken RH, Li S, Perman J, Viscidi R. Persistent diarrhea and fecal
shedding of retroviral nucleic acids in children infected with human
immunodeficiency virus. J Infect Dis 1991;164:61-6.
11. CDC. Recommendations for prevention of HIV transmission in health-care
settings. MMWR 1987;36(no. 2S).
* Single copies of this report will be available free until May 20, 1995,
from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD
20849-6003; telephone (800) 458-5231 or (301) 217- 0023.
------------------------------
Date: Sun, 22 May 94 22:37:15 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: [MMWR] Tornado Disaster
Message-ID: <s5JRmc4w165w@stat.com>
Tornado Disaster -- Alabama, March 27, 1994
On Sunday, March 27, 1994, a series of severe thunderstorms and
tornadoes moved across Alabama, Tennessee, Georgia, North Carolina, and
South Carolina. These storms accounted for injuries to at least 422
persons, including 47 fatalities. Twenty-three fatalities were associated
with a tornado that cut a path across St. Clair, Calhoun, and Cherokee
counties in northeastern Alabama from 10:55 a.m. to 11:39 a.m. (Figure 1).
This tornado damaged or destroyed three churches while services were being
conducted. This report provides a summary of the injuries and deaths
associated with this tornado based on information from death certificates
from coroners' offices in the three counties and from emergency department
and inpatient medical records from eight area hospitals.
Of 144 persons who sustained nonfatal injuries and sought
hospital-based medical care, 87 (60%) were treated and released; primary
diagnoses included contusions/ abrasions (39 [45%]), lacerations (27
[31%]), fractures (six [7%]), and other trauma (15 [17%]). Fifty-seven
(40%) persons were hospitalized; primary diagnoses included fractures (23
[40%]), multiple trauma (12 [21%]), head trauma (10 [18%]), and other
trauma (12 [21%]).
Twenty of the 23 deaths occurred when the tornado destroyed a church
in southern Cherokee County (Table 1). Two persons were killed while inside
automobiles, and one died outdoors at a boat ramp. The mean age of the
decedents was 35 years (range: 2-79 years). The immediate cause of death
for 22 persons was severe head trauma with multiple injuries; for one
person, the cause was hemorrhagic shock with multiple trauma.
The National Weather Service issued severe thunderstorm warnings for
eastern Jefferson and St. Clair counties at 10:24 a.m. and issued a tornado
warning for Etowah and Calhoun counties at 10:49 a.m. The tornado warnings
broadcast over radio and television advised persons to seek immediate
shelter. At 10:53 a.m., local television and radio stations broadcast a
tornado warning for St. Clair County. At 10:55 a.m., the tornado struck
southwest of Ragland in St. Clair County. At 11:27 a.m., a revised tornado
warning was issued for northern Calhoun, southeastern Etowah, and southern
Cherokee counties. At 11:39 a.m., the church in Cherokee County,
approximately 32 miles northeast of the tornado's initial point of impact,
was destroyed.
The tornado's path was one fourth to one half mile wide and
approximately 50 miles long. Because of its extremely rapid development and
rapid ground speed (60 mph), this tornado was sighted only 5 minutes before
it touched down, despite use of Doppler radar.
Reported by: R Curley, Jacksonville Hospital, Jacksonville; L Ramsey,
Northeast Alabama Regional Medical Center, L Burdette, Stringfellow
Memorial Hospital, JL Bennett, Calhoun County Emergency Management Agency,
P Hulsey, Calhoun County Coroner, Anniston; L Doeg, Cherokee Baptist
Medical Center, L Tucker, Cherokee County Coroner, Centre; D Norrell,
Baptist Medical Center- De Kalb, Fort Payne; D Brittian, Gadsden Regional
Medical Center, C Turner, Riverview Regional Medical Center, Gadsden; S
Evans, St. Clair Regional Hospital, J Wyatt, St. Clair County Coroner, Pell
City; TR Nielsen, L Burell, Public Health Area IV, Anniston; CH Woernle,
MD, State Epidemiologist, Alabama Dept of Public Health. B Peters, National
Weather Svc, Huntsville, Alabama. Disaster Assessment and Epidemiology
Section, Health Studies Br, Div of Environmental Hazards and Health
Effects, National Center for Environmental Health; Chronic Disease
Prevention Br, Div of Nutrition, National Center for Chronic Disease
Prevention and Health Promotion, CDC.
Editorial Note: Tornadoes are one of the most lethal and violent of all
natural disasters; in the United States during 1953-1992, tornadoes
accounted for 3653 fatalities (1). Tornadoes have occurred in every state
and during every month of the year (2). The Fujita Tornado Scale (F0-F6)
ranks tornadoes according to their speed, path length, and path width. The
March 27 tornado was ranked as a Fujita level 4, which is among the top 3%
of the most violent tornadoes.
Local implementation of prevention and control measures in conjunction
with tornado "watches" and "warnings" issued by the National Weather
Service (3,4) include the establishment of local observer networks,
installation of warning systems (e.g., alarms or sirens), and education of
the public about when and where to take shelter (4). Previous
investigations have suggested an increased risk for injury or death among
persons who are inside mobile homes or vehicles when tornadoes strike
(3-6). The findings in Alabama suggest that persons inside some public
buildings also may be at risk. The findings also emphasize the role of
local observer networks in providing timely warnings to communities in the
projected path of a tornado. Additional measures include alarms, sirens, or
warning devices that are not dependent on radio or television broadcast and
can be activated when National Weather Service tornado warnings are issued
or when local public safety authorities note the approach of severe
weather.
The National Oceanic and Atmospheric Administration recommends the
following prevention measures for persons in areas in which tornado
warnings have been issued: 1) persons in permanent homes should go to a
basement, hallway, closet, or interior room and cover themselves with
pillows, blankets, or mattresses; 2) persons in mobile homes should seek
shelter in a permanent structure (mobile home tiedowns are ineffective at
wind speeds above 50 mph); 3) in rural areas, persons in vehicles should
leave their vehicles and lie flat in the nearest gully or ditch; and 4) in
urban areas, persons in vehicles should leave their vehicles and seek
shelter in a permanent structure, and persons in buildings without
basements should go to a small interior room or hallway (4).
References
1. National Climatic Data Center. Storm data and unusual weather phenomena,
with late reports and corrections. Asheville, North Carolina: National
Oceanic and Atmospheric Administration, National Climatic Data Center,
1992;34(12):90.
2. Fujita TT. U.S. tornadoes, part one: 70-year statistics. Chicago: The
University of Chicago, Department of Geophysical Sciences, 1987:103.
3. CDC. Tornado disaster--Kansas, 1991. MMWR 1992;41:181-3.
4. Sanderson LM. Tornadoes. In: Gregg MB, ed. The public health
consequences of disasters, 1989. Atlanta: US Department of Health and Human
Services, Public Health Service, CDC, 1989:39-49.
5. CDC. Tornado disaster--Illinois, 1990. MMWR 1991;40:33-6.
6. Glass RI, Craven RB, Bregman DJ, et al. Injuries from the Wichita Falls
tornado: implications for prevention. Science 1980;207:734-8.
------------------------------
Date: Sun, 22 May 94 22:38:10 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: FDA Reviews Antihistamine Mouse Study
Message-ID: <B7JRmc5w165w@stat.com>
FDA Reviews Antihistamine Mouse Study May 17, 1994
--- ------- ------------- ----- ----- --- --- ----
FDA has received inquiries about a study published in the May
18, l994, Journal of the National Cancer Institute that suggests
the antihistamines loratidine, astemizole and hydroxyzine act to
stimulate the growth of tumors transplanted into mice. The
authors, at the Manitoba Institute of Cell Biology at the
University of Manitoba in Canada, had previously published a paper
suggesting that certain antidepressants accelerate the growth of
existing tumors in mice.
FDA has been following these reports. The agency believes
that further study is needed to determine whether these kinds of
animal data suggest a potential concern for human use of the drugs.
No clinical data support the findings, and standard carcinogenicity
studies with loratidine and astemizole in mice and rats do not
demonstrate carcinogenicity. The agency does not believe,
therefore, that changes in the drugs' labeling or approval status
are warranted. FDA is advising consumers that short term use is
not at issue.
Loratidine, astemizole and hydroxyzine are prescription drugs
used for relief of hay fever, allergies and itching. FDA is
attempting to duplicate the results of the reported animal studies
and is evaluating the feasibility of epidemiologic studies in
patients with cancer. In addition, FDA will conduct studies to
examine whether additional types of tumors show a similar response
when transplanted in animals. The agency also is working with the
article's authors to obtain additional data.
------------------------------
Date: Mon, 23 May 94 06:34:17 MST
From: mednews (HICNet Medical News)
To: hicnews
Subject: Institute of Tropical Medicine Epidemiological Bulletin
Message-ID: <u86Rmc1w165w@stat.com>
IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.11
Date: 03/19/94
Institute of Tropical Medicine Pedro Kouri
National Epidemiology Office
Ministry of Public Health
------------------------------------------------------------
Cuba. Cases and Cumulative of selected notifiable diseases.
Week ending 03/19/94.
------------------------------------------------------------
DISEASES IN THIS WEEK CUMULATIVE
1992 1993 1992 1993
------------------------------------------------------------
TYPHOID FEVER * 1 6 9
SHIGELLOSIS 21 5 45 49
AMEBIAN D. 160 11 1277 90
TUBERCULOSIS 11 14 136 162
HANSEN DISEASE 7 4 33 23
PERTUSSIS 4 * 4 *
SCARLET FEVER 9 4 104 75
MENINGOCOCCAL M.(1) 0 2 12 12
MENINGOCCEMIES(1) * 1 3 2
TETANUS * * * *
VIRAL M. 65 65 523 916
BACTERIAL M. 31 33 292 283
VARICELLA 1859 1226 11948 9897
MEASLES * * * *
RUBELLA * * * *
VIRAL HEPATITIS 375 376 3630 2932
MUMPS * * * *
MALARIA * * 2 12
LEPTOSPIROSIS 6 13 79 209
SYPHILIS 201 205 2072 2337
GONORRHEA 398 451 4417 5035
ACUMINATA COND. 25 38 432 360
------------------------------------------------------------
Source: 1993, MND (Written Report) EIG-IPK.
1994, MND (Phone Report) EIG-IPK.
(1) DIS
* Means 0 reported case.
Notified Outbreaks. Week 03/17/94 - 03/23/94.
------------------------------------------------------------
DISEASES OUTBREAKS CASES PROVINCES
------------------------------------------------------------
A.D.D. 1 49 PROV. HABANA
------------------------------------------------------------
F.T.D. 10 251 MATANZAS 1/3
CIENFUEGOS 1/16
CAMAGUEY 3/105
HOLGUIN 2/73
GRANMA 1/28
GUANTANAMO 2/26
------------------------------------------------------------
Source: DIS.
------------------------------------------------------------
This bulletin was prepared with the 85% of provinces-
days-information.
The offered indexes are provisionals and were taken from
the daily report of the Direct Information System (DIS)
remitted by Provincial Centers of Hygiene and
Epidemiology, from the weekly phone report of Mandatory
Notifiable Diseases (MND) remitted by National Statistics
Division of the Ministry of Public Health, and from the
Reference Laboratories of the Institute of Tropical
Medicine Pedro Kouri.
------------------------------------------------------------
This is the weekly IPK-Epidemiological Bulletin emitted
via Electronic Mail. The numbering plan agree with the
IPK-Epidemiological Bulletin edited by Institute of
Tropical Medicine Pedro Kouri and it is an abbreviated
version.
Lic. Andres M. Alonso ipk-b@infomed.cu
IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.12
Date: 03/26/94
Institute of Tropical Medicine Pedro Kouri
National Epidemiology Office
Ministry of Public Health
------------------------------------------------------------
Cuba. Cases and Cumulative of selected notifiable diseases.
Week ending 03/26/94.
------------------------------------------------------------
DISEASES IN THIS WEEK CUMULATIVE
1992 1993 1992 1993
------------------------------------------------------------
TYPHOID FEVER * 4 6 13
SHIGELLOSIS 16 1 82 50
AMEBIAN D. 159 1 1436 91
TUBERCULOSIS 10 21 146 183
HANSEN DISEASE 6 6 39 29
PERTUSSIS * * 4 *
SCARLET FEVER 13 15 117 90
MENINGOCOCCAL M.(1) 4 1 17 13
MENINGOCCEMIES(1) 1 * 4 2
TETANUS * * * *
VIRAL M. 41 86 564 1002
BACTERIAL M. 11 24 303 307
VARICELLA 2365 1878 14313 11775
MEASLES * * * *
RUBELLA * * * *
VIRAL HEPATITIS 360 318 3990 3250
MUMPS * * * *
MALARIA * 1 2 2
LEPTOSPIROSIS 14 12 93 221
SYPHILIS 162 221 2234 2558
GONORRHEA 319 529 4736 5564
ACUMINATA COND. 59 43 491 403
------------------------------------------------------------
Source: 1993, MND (Written Report) EIG-IPK.
1994, MND (Phone Report) EIG-IPK.
(1) DIS
* Means 0 reported case.
Notified Outbreaks. Week 03/24/94 - 03/30/94.
------------------------------------------------------------
DISEASES OUTBREAKS CASES PROVINCES
------------------------------------------------------------
A.D.D. 1 40 SANCTI SPIRITUS
------------------------------------------------------------
F.T.D. 4 103 MATANZAS 1/1
VILLA CLARA 2/98
CIEGO DE AVILA 1/4
------------------------------------------------------------
VIRAL HEP. 1 2 CIENFUEGOS
------------------------------------------------------------
VARICELLA 2 9 PROV.HABANA 1/4
HOLGUIN 1/5
------------------------------------------------------------
Source: DIS.
------------------------------------------------------------
This bulletin was prepared with the 64% of provinces-days-
information.
The offered indexes are provisionals and were taken from
the daily report of the Direct Information System (DIS)
remitted by Provincial Centers of Hygiene and
Epidemiology, from the weekly phone report of Mandatory
Notifiable Diseases (MND) remitted by National Statistics
Division of the Ministry of Public Health, and from the
Reference Laboratories of the Institute of Tropical
Medicine Pedro Kouri.
------------------------------------------------------------
This is the weekly IPK-Epidemiological Bulletin emitted
via Electronic Mail. The numbering plan agree with the
IPK-Epidemiological Bulletin edited by Institute of
Tropical Medicine Pedro Kouri and it is an abbreviated
version.
Lic. Andres M. Alonso ipk-b@infomed.cu
IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.13
Date: 04/02/94
Institute of Tropical Medicine Pedro Kouri
National Epidemiology Office
Ministry of Public Health
------------------------------------------------------------
Cuba. Cases and Cumulative of selected notifiable diseases.
Week ending 04/02/94.
------------------------------------------------------------
DISEASES IN THIS WEEK CUMULATIVE
1992 1993 1992 1993
------------------------------------------------------------
TYPHOID FEVER * 1 6 14
SHIGELLOSIS 5 1 66 51
AMEBIAN D. 6 15 1442 66
TUBERCULOSIS 20 17 166 200
HANSEN DISEASE 2 3 41 32
PERTUSSIS * * 4 *
SCARLET FEVER 9 9 126 99
MENINGOCOCCAL M.(1) 3 * 20 13
MENINGOCCEMIES(1) * * 4 2
TETANUS * * * *
VIRAL M. 54 80 618 1082
BACTERIAL M. 14 40 317 347
VARICELLA 2495 2254 16808 14029
MEASLES * * * *
RUBELLA * * * *
VIRAL HEPATITIS 399 418 4389 3668
MUMPS * * * *
MALARIA * * 2 1
LEPTOSPIROSIS 19 23 112 244
SYPHILIS 210 219 2444 2777
GONORRHEA 459 581 5195 6145
ACUMINATA COND. 38 33 529 435
------------------------------------------------------------
Source: 1993, MND (Written Report) EIG-IPK.
1994, MND (Phone Report) EIG-IPK.
(1) DIS
* Means 0 reported case.
Notified Outbreaks. Week 03/31/94 - 04/06/94.
------------------------------------------------------------
DISEASES OUTBREAKS CASES PROVINCES
------------------------------------------------------------
A.D.D. 2 45 SANTIAGO DE CUBA
------------------------------------------------------------
F.T.D. 11 290 GRANMA 1/14
VILLA CLARA 2/95
CAMAGUEY 6/118
HOLGUIN 2/63
------------------------------------------------------------
VIRAL HEP. 2 137 SANTIAGO DE CUBA
------------------------------------------------------------
T.B. 1 3 HOLGUIN
------------------------------------------------------------
Source: DIS.
------------------------------------------------------------
This bulletin was prepared with the 71% of provinces-days-
information.
The offered indexes are provisionals and were taken from
the daily report of the Direct Information System (DIS)
remitted by Provincial Centers of Hygiene and
Epidemiology, from the weekly phone report of Mandatory
Notifiable Diseases (MND) remitted by National Statistics
Division of the Ministry of Public Health, and from the
Reference Laboratories of the Institute of Tropical
Medicine Pedro Kouri.
------------------------------------------------------------
This is the weekly IPK-Epidemiological Bulletin emitted
via Electronic Mail. The numbering plan agree with the
IPK-Epidemiological Bulletin edited by Institute of
Tropical Medicine Pedro Kouri and it is an abbreviated
version.
Lic. Andres M. Alonso ipk-b@infomed.cu
IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.14
Date: 04/09/94
Institute of Tropical Medicine Pedro Kouri
National Epidemiology Office
Ministry of Public Health
------------------------------------------------------------
Cuba. Cases and Cumulative of selected notifiable diseases.
Week ending 04/09/94.
------------------------------------------------------------
DISEASES IN THIS WEEK CUMULATIVE
1992 1993 1992 1993
------------------------------------------------------------
TYPHOID FEVER 1 * 7 14
SHIGELLOSIS 16 4 82 55
AMEBIAN D. 12 5 1454 71
TUBERCULOSIS 9 24 175 224
HANSEN DISEASE 10 8 51 40
PERTUSSIS * * 4 *
SCARLET FEVER 6 8 132 107
MENINGOCOCCAL M.(1) 1 5 25 22
MENINGOCCEMIES(1) * * 4 4
TETANUS * * * *
VIRAL M. 49 54 667 1136
BACTERIAL M. 21 19 338 366
VARICELLA 2201 1733 19009 15762
MEASLES * * * *
RUBELLA * * * *
VIRAL HEPATITIS 322 420 4711 4088
MUMPS * * * *
MALARIA * * 2 1
LEPTOSPIROSIS 9 19 121 263
SYPHILIS 164 224 2608 3001
GONORRHEA 367 518 5562 6663
ACUMINATA COND. 42 57 571 492
------------------------------------------------------------
Source: 1993, MND (Written Report) EIG-IPK.
1994, MND (Phone Report) EIG-IPK.
(1) DIS
* Means 0 reported case.
Notified Outbreaks. Week 04/07/94 - 04/13/94.
------------------------------------------------------------
DISEASES OUTBREAKS CASES PROVINCES
------------------------------------------------------------
A.D.D. 4 223 PROV.HABANA 1/6
VILLA CLARA 1/66
CIEGO DE AVILA 2/151
------------------------------------------------------------
F.T.D. 4 45 MATANZAS 1/1
HOLGUIN 2/31
GUANTANAMO 1/13
------------------------------------------------------------
VIRAL HEP. 1 133 VILLA CLARA
------------------------------------------------------------
VARICELLA 1 5 PROV.HABANA
------------------------------------------------------------
Source: DIS.
------------------------------------------------------------
This bulletin was prepared with the 70% of provinces-days-
information.
The offered indexes are provisionals and were taken from
the daily report of the Direct Information System (DIS)
remitted by Provincial Centers of Hygiene and
Epidemiology, from the weekly phone report of Mandatory
Notifiable Diseases (MND) remitted by National Statistics
Division of the Ministry of Public Health, and from the
Reference Laboratories of the Institute of Tropical
Medicine Pedro Kouri.
------------------------------------------------------------
This is the weekly IPK-Epidemiological Bulletin emitted
via Electronic Mail. The numbering plan agree with the
IPK-Epidemiological Bulletin edited by Institute of
Tropical Medicine Pedro Kouri and it is an abbreviated
version.
Lic. Andres M. Alonso ipk-b@infomed.cu
IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.15
Date: 04/16/94
Institute of Tropical Medicine Pedro Kouri
National Epidemiology Office
Ministry of Public Health
------------------------------------------------------------
Cuba. Cases and Cumulative of selected notifiable diseases.
Week ending 04/16/94.
------------------------------------------------------------
DISEASES IN THIS WEEK CUMULATIVE
1992 1993 1992 1993
------------------------------------------------------------
TYPHOID FEVER 1 * 7 14
SHIGELLOSIS 2 * 84 55
AMEBIAN D. 19 4 1473 115
TUBERCULOSIS 14 13 183 237
HANSEN DISEASE 3 6 54 46
PERTUSSIS * * 4 *
SCARLET FEVER 8 2 140 109
MENINGOCOCCAL M.(1) 4 2 25 22
MENINGOCCEMIES(1) * 2 4 4
TETANUS * * * *
VIRAL M. 39 64 706 1200
BACTERIAL M. 7 29 345 395
VARICELLA 1676 1427 20685 17189
MEASLES * * * *
RUBELLA * * * *
VIRAL HEPATITIS 355 414 5066 4502
MUMPS * * * *
MALARIA * * 2 1
LEPTOSPIROSIS 7 1 128 264
SYPHILIS 167 221 2775 3222
GONORRHEA 323 519 5885 7182
ACUMINATA COND. 55 45 626 538
------------------------------------------------------------
Source: 1993, MND (Written Report) EIG-IPK.
1994, MND (Phone Report) EIG-IPK.
(1) DIS
* Means 0 reported case.
Notified Outbreaks. Week 04/07/94 - 04/13/94.
------------------------------------------------------------
DISEASES OUTBREAKS CASES PROVINCES
------------------------------------------------------------
A.D.D. 1 129 PINAR DEL RIO
------------------------------------------------------------
F.T.D. 3 122 SANCTI SPIRITUS 1/59
VILLA CLARA 2/63
------------------------------------------------------------
VIRAL HEP. 1 5 PINAR DEL RIO
------------------------------------------------------------
CHEMICAL INT. 1 14 PROV.HABANA
------------------------------------------------------------
Source: DIS.
------------------------------------------------------------
This bulletin was prepared with the 75% of provinces-days-
information.
The offered indexes are provisionals and were taken from
the daily report of the Direct Information System (DIS)
remitted by Provincial Centers of Hygiene and
Epidemiology, from the weekly phone report of Mandatory
Notifiable Diseases (MND) remitted by National Statistics
Division of the Ministry of Public Health, and from the
Reference Laboratories of the Institute of Tropical
Medicine Pedro Kouri.
------------------------------------------------------------
This is the weekly IPK-Epidemiological Bulletin emitted
via Electronic Mail. The numbering plan agree with the
IPK-Epidemiological Bulletin edited by Institute of
Tropical Medicine Pedro Kouri and it is an abbreviated
version.
Lic. Andres M. Alonso ipk-b@infomed.cu
------------------------------
End of HICNet Medical News Digest V07 Issue #21
***********************************************
---
Editor, HICNet Medical Newsletter
Internet: david@stat.com FAX: +1 (602) 451-1165
Bitnet : ATW1H@ASUACAD
-------------------------------------------------------------------------------