MMWR – Morbidity and Mortality Weekly Report

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1. Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States, November 2012–July 2013

CDC Media Relations
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Lyme carditis is a known but rare cause of sudden cardiac death. Lyme carditis can cause heart palpitations, chest pain, light-headedness, fainting, and shortness of breath in addition to the commonly recognized Lyme disease symptoms of fever, rash, and body aches. If you live in an area where Lyme disease is common and have these symptoms, see a healthcare provider immediately. Between November 2012 and July 2013, three young adults who lived in high-incidence Lyme disease regions suffered from sudden cardiac death associated with undiagnosed Lyme carditis.  Lyme carditis is a known, but rare cause of death in persons who have Lyme disease. The CDC and state and local health departments investigated these three deaths. Two of the three individuals who died had corneas transplanted to three separate recipients before the cause of death was notified, but there was no evidence of disease transmission. Prompt recognition and early, appropriate therapy for Lyme disease with antibiotics is essential. These deaths underscore the urgent need for better methods of primary prevention of Lyme disease and other tickborne infections.

2. Influenza Illnesses and Hospitalizations Averted by Influenza Vaccination — United States, 2012–13 Influenza Season

CDC Media Relations
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Influenza vaccination produces a substantial health benefit in terms of preventing illness, medical visits and hospitalizations, but further raising vaccination rates and producing more effective vaccines would greatly increase the benefits realized by influenza vaccination in the United States. In this report, CDC uses a model first published in June 2013 to estimate the number of influenza-associated illnesses, medically attended illnesses and hospitalizations that were prevented last season as a result of flu vaccination. Based on this model, CDC estimates that flu vaccination in 2012-2013 reduced the numbers of flu illnesses, medically attended illnesses and hospitalizations by 17 percent over what would have occurred in the absence of influenza vaccination. This report shows the benefits of the flu vaccination program in terms of reducing flu illnesses, including serious illnesses resulting in hospitalizations.

3. Seasonal Influenza Vaccination Coverage Among Women Who Delivered a Live-Born Infant — 21 States and New York City, 2009–10 and 2010–11 Influenza Seasons

CDC Media Relations
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Our findings indicate a need to educate pregnant women and their health care providers about the need for seasonal influenza vaccine any time during pregnancy. Because pregnant women are at increased risk for complications from influenza, the Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice recommend that women get vaccinated anytime during pregnancy.  Data from the Pregnancy Risk Assessment and Monitoring System shows an increase in seasonal influenza vaccination coverage for women with recent births rising from a median of 50 percent in 2009-10 to a median of 55 percent for 2010-11 season.  Common reasons for not vaccination include not worried about getting sick from the flu and worry about the safety of the vaccine for self and baby.  For those vaccinated during pregnancy, higher proportions were vaccinated during the second or third trimester of pregnancy and close to half were vaccinated in their Ob/GYN’s office.  Coverage was higher for women whose provider recommended or offered vaccination than among those who did not.

4. Progress in Immunization Information Systems — United States, 2012

CDC Media Relations
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In order to realize the full benefits of Immunization information systems (IIS), progress is needed to reach lifespan participation in IIS, advanced bidirectional HL7 messaging between IIS and electronic health records, and to improve data quality in IIS. IIS consolidate vaccination data, are a proven tool to increase vaccination rates, and will be most effective if progress continues in lifespan participation, Health Level 7 (HL7) interoperability, and data quality standards. An annual survey of immunization programs shows 86 percent of U.S. children under 6 years of age have immunization information in IIS; however, adult participation in IIS was only 25 percent. Additionally, eight of 12 minimum functional standards for IIS published by the National Vaccine Advisory Committee have been met by 90 percent or more grantees, but progress can increase in advanced HL7 functionality and completeness and timeliness of records. Initiatives designed to increase adult participation in IIS, and promotion of HL7 messaging and electronic health records use among providers through meaningful use stage 2, are expected to support progress in these areas.

5. Progress Toward Poliomyelitis Eradication — Nigeria, January 2012–September 2013

CDC Media Relations
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Wild poliovirus transmission in Nigeria is a threat to the global polio eradication initiative. Unless an intensive, comprehensive immunization strategy and improvements in campaign implementation succeed in reaching all unimmunized children and in increasing community demand for routine vaccination, transmission may not be interrupted in 2014. Nigeria is the only country in Africa where wild poliovirus (WPV) transmission has never been interrupted. During the last decade, the country has been a reservoir for polio outbreaks in over two dozen countries. However, in 2013, polio cases are on the decline in Nigeria. WPV type 3 has not been reported since November 2012. WPV type 1 is still circulating in the country but is more geographically localized. With 49 polio cases reported in 2013 through September, this is a decrease of >50 percent compared to last year. Security and poorly implemented polio campaigns in selected areas are impeding efforts to interrupt transmission.  To address ongoing WPV transmission, Nigeria restructured the national polio response resources and intensified efforts to reach missed children through routine immunization and improved campaigns.

6. Extent and Effects of Recurrent Shortages of Purified Protein Derivative Tuberculin Skin Test Antigen Solutions — United States, 2013

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
404-639-8895
NCHHSTPMediaTeam@cdc.gov

Shortages of skin test solutions used to detect tuberculosis infection -- reported by U.S. public health programs over the past year -- have caused many TB programs to change testing practices.  Tuberculin skin tests (TSTs) are one of two types of tests available to detect TB infection.  Two TST solutions are FDA-approved: Tubersol, which has been unavailable intermittently since late 2012, and Apisol, which has seen an increase in demand as supplies of Tubersol have been limited.  An August 2013 CDC survey of TB control programs across the country found that more than half (56 percent of responding programs) have experienced shortages of at least one of these test solutions, to the point where routine activities were threatened or stopped altogether.  Several programs not experiencing shortages took preemptive steps, such as suspending routine testing, and some reported increasing the use of blood tests instead of skin tests to detect TB infection.  All TST solutions are now available and returning to the market, and supplies are expected to return to normal by early next year.  In the interim, CDC recommends that public health programs: 1). Switch to blood tests instead of TSTs to detect TB infection; 2). Prioritize the use of available TSTs; or 3). Substitute Apisol for Tubersol for skin testing, as available.  In settings where TB exposure is unlikely, the deferment of routine serial testing should be considered. 

7. Notes from the Field

Severe Illness Associated with Reported Synthetic Marijuana Exposure — Colorado, August–September 2013

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES