Synopsis for January 28, 2005

The MMWR is embargoed until Thursday, 12 PM EDT.

1. Rapid Health Response, Assessment, and Surveillance After a Tsunami ― Thailand, 2004-2005
2. Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit ― South Carolina, 2005; Selected States
3. Outbreaks of Pertussis Associated with Hospitals ― Kentucky, Pennsylvania, and Oregon, 2003
4. Fatal Case of Pertussis in an infant ― West Virginia, 2004
5. Outbreak of Invasive Pneumococcal Disease ― Alaska, 2003-2004

Rapid Health Response, Assessment, and Surveillance After a Tsunami ― Thailand, 2004-2005

No Summary Available.

Public Health Consequences from Hazardous Substances Acutely Released During Rail Transit ― South Carolina, 2005; Selected States

Findings from the HSEES system suggest that rail events constitute a small percentage of total hazardous-substance–release events. However, large-scale, acute releases during rail transit do occur and cause substantial injury and death, as demonstrated by the South Carolina event and the other case reports. Local government, employers, and first responders can help reduce morbidity and mortality from transit-associated hazardous-substance–releases by implementing various measures such as examining historical spill data, developing emergency response plans, and providing hazardous materials training where appropriate.

Thousands of hazardous substance shipments transit daily throughout the United States by rail. Although a high percentage of these materials safely reach their destinations, many frequently are transported through densely populated or sensitive areas where the consequences of an acute release could result in environmental damage, severe injury, or death. In response to the recent train derailment/chlorine release in South Carolina in January, 2005, data from the Agency for Toxic Substances and Disease Registry’s Hazardous Substances Emergency Events Surveillance (HSEES) system were examined. HSEES is a surveillance system that was established to collect and analyze information about certain emergency events related to chemical releases. This report describes the event in South Carolina and two others, and summarizes all rail events based on those reported to HSEES from 16 state health departments during 1999–2004.

For a fact sheet outlining this article and additional resources related to the ATSDR HSEES system and the January 2005 chemical release in Aiken, South Carolina: www.atsdr.cdc.gov/HS/HSEES/sctrain.html.

Outbreaks of Pertussis Associated with Hospitals ― Kentucky, Pennsylvania, and Oregon, 2003

Health care workers may get pertussis from coughing patients or other hospital staff who do not know they have it and transmit the infection to vulnerable patients and to their coworkers.

Pertussis (or whooping cough) outbreaks among health care workers are of special concern because of the risk of transmission to vulnerable patients. Mild and atypical manifestations of pertussis among some infected persons and the lack of quick and accurate diagnostic tests make pertussis outbreaks difficult to recognize and therefore difficult to control. The three pertussis outbreaks reported here illustrate the importance of complying with droplet precautions to reduce hospital transmission of pertussis when evaluating or caring for patients with acute respiratory distress or cough illness of unknown cause. Control measures associated with pertussis in a hospital can be costly for both hospitals and hospital employees as well as for the public health system and society at large.

Fatal Case of Pertussis in an infant ― West Virginia, 2004

Caretakers of infants should not expose infants to individuals with cough illnesses.

Pertussis, also known as whooping cough, can be a life-threatening illness in unvaccinated or partially vaccinated infants. Health care providers should consider pertussis in the differential diagnoses in adolescents and adults with prolonged cough illnesses and should recommend culture for confirmation of diagnosis. Health-care providers must be encouraged to observe droplet precautions while attending to patients with respiratory illnesses. If a vaccine becomes licensed for use in adolescents and adults in the U.S., consideration should be given to evaluating vaccination strategies to prevent transmission to infants.

Outbreak of Invasive Pneumococcal Disease ― Alaska, 2003-2004

Much of invasive pneumococcal disease in adults is preventable through vaccination and opportunities for vaccination of the elderly and medically frail should not be missed.

An outbreak of 14 cases pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, occurred during 2003-04 in rural Alaska. An effective vaccine is available to help prevent pneumococcal disease. In the Alaska outbreak, adequate vaccination might have prevented 50 percent of cases. Typically, elderly persons and persons with weakened medical conditions are at increased risk for pneumococcal disease and should be vaccinated. Standing orders, a medical policy that allows clinical staff to vaccinate persons who are eligible without the need for a physician’s exam or direct order, are an effective way to improve vaccination rates. In response to the outbreak, standing orders for pneumococcal vaccination were implemented in the affected region. Medical providers should identify and address barriers to vaccination and consider use of standing orders to improve vaccination rates and reduce morbidity and mortality.

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