Synopsis for August 8, 2003

The MMWR is embargoed until NOON ET, Thursdays.

1. Imported Plague — New York City, 2003
2. National, State, and Urban Area Vaccination Levels Among Children Aged 19–35 Months — 2002
3. Vaccination Services in Postwar Iraq, May 2003
4. Update: Adverse Event Data and Revised American Thoracic Society/CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection — United States, 2003
5. Pneumococcal Vaccination for Cochlear Implant Candidates and Recipients: Updated Recommendations of the Advisory Committee on Immunization Practices
6. West Nile Virus Activity — United States, July 31– August 6, 2003

Synopsis for August 8, 2003

Imported Plague — New York City, 2003

Bubonic plague can be treated successfully if treatment begins early in the disease course.

Plague is a rodent-associated bacterial illness. The disease occurs naturally in seventeen western states. The disease is maintained in the environment through transmission between certain rodents and their fleas. Other mammals can become infected and some, including humans, suffer severe disease and high mortality. Human cases are usually acquired through the bites of infectious fleas; however, direct contact with the tissues or body fluids of infected animals and, rarely, inhalation of infectious materials can transmit the disease. Since the plague bacteria can cause severe human illness and is a potential agent of bioterrorism any patient suspected of having plague should be evaluated promptly for treatment and to determine the source of infection.

National, State, and Urban Area Vaccination Levels Among Children Aged 19–35 Months — 2002

Immunization coverage for 19-35 month old children in the United States remains at near-record highs.

Coverage for varicella vaccine achieved a record high of 80.6%. Coverage with pneumococcal vaccine, reported for the first time, reached 40.9%. Although coverage with recommended vaccines remains high, vigilance is needed to maintain these high levels. Eliminating disparities between states and urban areas with the highest and lowest coverage remains a public health priority.

Vaccination Services in Postwar Iraq, May 2003

The restoration of important public health programs in Iraq, such as routine childhood immunizations, is underway and significant achievements have been made.

The breakdown of civil order in Iraq, after the recent war, disrupted many public health programs including routine childhood vaccinations. In May, the Iraqi Ministry of Health (IMoH) sent teams around the country to assess refrigerated storage sites (cold chain) and the ability of the public health system to provide routine immunizations. At that time, 61% of primary healthcare centers had the equipment and staff to offer daily routine immunizations. The extent of the damage to cold chain equipment varied between the Iraqi governorates and ranged from 12% (Kerbala) to 64% (Missan). The Coalition Provisional Authority and the Iraqi Ministry of Health are working closely with international organizations and non-governmental organizations to re-establish secure public health programs throughout Iraq.

Update: Adverse Event Data and Revised American Thoracic Society/CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection — United States, 2003

CDC and the American Thoracic Society are recommending that the two-month drug regimen of rifampin and pyrazinmide (RZ) not be routinely offered to persons with latent tuberculosis infection (LTBI).

These recommendations are also endorsed by the Infectious Diseases Society of America. To date, CDC has identified 48 cases of severe liver injury, including 11 deaths, associated with the use of RZ for LTBI treatment. This article outlines data supporting the change in recommendations, including findings from a CDC survey of more than 100 healthcare providers. The providers surveyed prescribed RZ to nearly 8,000 LTBI patients from January 2000 to June 2002. CDC researchers reported that rates of hospitalization for those receiving RZ were at least 15 times higher than rates for patients receiving the standard treatment regimen of isoniazid (INH). Nine-months of INH continues to be recommended as the optimal LTBI treatment regimen. For more information about LTBI treatment, go to: www.cdc.gov/nchstp/tb/.

Pneumococcal Vaccination for Cochlear Implant Candidates and Recipients: Updated Recommendations of the Advisory Committee on Immunization Practices

No summary available.

West Nile Virus Activity — United States,
July 31– August 6, 2003

No summary available.

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