Publication of CDC Surveillance Summaries

Since 1983, CDC has published the CDC Surveillance Summaries under separate cover as part of the MMWR series. Each report published in the CDC Surveillance Summaries focuses on public health surveillance; surveillance findings are reported for a broad range of risk factors and health conditions.

Summaries for each of the reports published in the November 20, 1992, issue of the CDC Surveillance Summaries (1) are provided below. All subscribers to MMWR receive the CDC Surveillance Summaries, as well as the MMWR Recommendations and Reports, as part of their subscriptions. MEASLES SURVEILLANCE -- UNITED STATES, 1991

A total of 9643 measles cases was reported from the United States in 1991, a 65.3% decrease from the 27,786 cases reported in 1990. The overall incidence of measles was 3.9 cases per 100,000 population. The highest age-specific incidence was among children less than 12 months of age (46.9/100,000) and 1-4 years of age (19.6/100,000). Incidence rates among American Indian, Hispanic, and black children less than 5 years of age were 19, 6, and 4 times that for non-Hispanic white children, respectively. More than 61% of all cases were reported from seven large outbreaks, which involved predominantly unvaccinated preschool-aged children in large urban areas. Although reported measles cases decreased in 1991 compared with 1989-1990, only a sustained effort to provide age-appropriate vaccination will prevent another resurgence of measles. Authors: William L. Atkinson, M.D., M.P.H., Stephen C. Hadler, M.D., Susan B. Redd, Walter A. Orenstein, M.D., Division of Immunization, National Center for Prevention Services, CDC. YEARS OF POTENTIAL LIFE LOST BEFORE AGE 65, BY RACE, HISPANIC ORIGIN, AND SEX -- UNITED STATES, 1986-1988

A substantial proportion of mortality among young persons is preventable. National vital statistics were used to establish a baseline for the surveillance of rates of years of potential life lost before age 65 (YPLL less than 65) in the United States. Rates of YPLL less than 65 were calculated for 1986 through 1988 for leading causes of preventable death, by race, Hispanic origin, and sex. U.S. racial and ethnic populations differed widely in YPLL less than 65. Among males, the rate (per 1000 population less than 65 years) of YPLL less than 65 was highest for non-Hispanic blacks (140.0), followed by American Indians/Alaskan Natives (100.9), Hispanics (74.3), non-Hispanic whites (68.3), and Asians/Pacific Islanders (38.2). Among females, it was highest for non-Hispanic blacks (73.7), followed by American Indians/Alaskan Natives (52.0), non-Hispanic whites (35.7), Hispanics (32.9), and Asians/Pacific Islanders (23.2). For non-Hispanic blacks, the high rate of YPLL less than 65 was due to increased rates for all causes of death considered, particularly homicide. The high rate for American Indians/Alaskan Natives was due principally to deaths from four causes: unintentional injuries, cirrhosis, suicide, and diabetes. Asians/Pacific Islanders had low rates for most causes of death. In setting health-care priorities and prevention strategies to reduce the large racial-ethnic gap in early deaths, it is essential to recognize the differences in causes of premature mortality among sex, racial, and ethnic populations. Periodic reassessment of YPLL less than 65 among these groups provides a simple, timely, and representative means of conducting surveillance to measure the impact of intervention strategies on a national basis. Authors: Jean-Claude A. Desenclos, M.D., Hopital National de Saint-Maurice, European Centre for the Epidemiological Monitoring of AIDS. Robert A. Hahn, Ph.D., M.P.H., Division of Surveillance and Epidemiology, Epidemiology Program Office, CDC. GROUP B STREPTOCOCCAL DISEASE IN THE UNITED STATES, 1990: REPORT FROM A MULTISTATE ACTIVE SURVEILLANCE SYSTEM

Group B streptococcal (GBS) disease is the most common cause of neonatal sepsis and meningitis in the United States. It is also an important cause of morbidity among pregnant women and adults with underlying medical conditions. Because most states have not designated GBS disease as a reportable condition, previous estimates of the incidence of GBS disease were based on studies from single hospitals or small geographic areas. This report summarizes the results of population-based active surveillance for invasive GBS disease in counties within four states that had an aggregate population of 10.1 million persons in 1990. A case of GBS disease was defined as isolation of group B streptococcus from a normally sterile anatomic site in a resident of one of the surveillance areas.

Age- and race-adjusted projections to the U.S. population suggest that greater than 15,000 cases and greater than 1300 deaths due to GBS disease occur each year. The projected age- and race-adjusted national incidence is 1.8/1000 live births for neonatal GBS disease and 4.0/100,000 population per year for adult GBS disease. Intrapartum chemoprophylaxis for pregnant women at risk for delivering infants with GBS disease is the most effective strategy available for prevention of neonatal disease. Development of effective GBS vaccines may prevent GBS disease in both infants and adults. Ongoing surveillance for GBS disease is important for targeting preventive measures and determining their effectiveness. Authors: Group B Streptococcal Disease Study Group, Kenneth M. Zangwill, M.D., Anne Schuchat, M.D., Jay D. Wenger, M.D., Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Summaries for each of the reports published in the November 27, 1992, issue of the CDC Surveillance Summaries (2) are provided below. PEDIATRIC NUTRITION SURVEILLANCE SYSTEM -- UNITED STATES, 1980-1991

The CDC Pediatric Nutrition Surveillance System (PedNSS) monitors the general health and nutritional characteristics of low-income U.S. children who participate in multiple public health programs. This system is intended to characterize trends and patterns in key indicators of nutritional status so that the information can be used for program planning and targeting. The indicators monitored by PedNSS are birth weight, childhood growth status, anemia, and breast-feeding patterns. From 1980 through 1991, the trends for low birth weight, low height-for-age (shortness), low weight-for-height (thinness), and high weight-for-height (overweight) were stable for all children monitored by the PedNSS, with the exception of Asian children, who were predominantly of Southeast Asian refugee background. In the early 1980s, the prevalence of low birth weight and shortness was higher among Asian children than among children of other racial or ethnic groups who were monitored by the PedNSS. However, these prevalences declined steadily from 1980 through 1991. By 1991, the prevalences of low birth weight and shortness for Asian children were similar to those observed for children of other races/ethnic groups. Overall, low-income U.S. children had a slightly lower height-for-age than expected, indicating that some of these children were at a health and nutritional disadvantage. The prevalence of overweight varied among different racial/ethnic groups; Hispanic and Native American children had the highest prevalences of overweight. The 20%-30% prevalence of anemia among low-income children monitored by the PedNSS was higher than among the general population, reflecting in part the preferential enrollment and retention of anemic children by public health nutrition programs and also indicating that many children had inadequate iron nutrition. From 1980 through 1991, the prevalence of anemia declined greater than 5% for most of the age- and race/ethnicity-specific groups monitored by PedNSS. That decline represents an improvement in iron nutritional status. PedNSS is a useful system for the monitoring and characterization of the nutrition status of low-income children at both state and national levels. Authors: Ray Yip, M.D., M.P.H., Ibrahim Parvanta, M.S., Kelley Scanlon, Ph.D., R.D., Ellen W. Borland, Carl M. Russell, D.M.D., M.S., Frederick L. Trowbridge, M.D., M.Sc., Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC. PREGNANCY NUTRITION SURVEILLANCE SYSTEM -- UNITED STATES, 1979-1990

Since 1979, the CDC Pregnancy Nutrition Surveillance System (PNSS) has monitored behavior and nutritional risk factors among low-income pregnant women participating in public health programs. Although the states contributing to the system have varied over the period, the PNSS is able to characterize the behavior and health outcomes of pregnant women from diverse low-income populations. In 1990, 66.2% of the women in the system initiated prenatal care during the first trimester of pregnancy; 26.4% smoked during pregnancy. Since 1979, the prevalence of smoking remained relatively stable for white women, but declined for blacks and Hispanics. Prepregnancy body mass index (BMI, defined as kg/m2) showed marked changes from 1979 through 1990; the prevalence of underweight (BMI less than 19.8) declined steadily and the prevalence of overweight (BMI greater than 26) increased steadily. In 1990, 39.3% of the women had gestational weight gains below levels recommended by the National Academy of Sciences. Both prepregnancy underweight and inadequate gestational weight gain were associated with greater risk for low birth weight in the PNSS. The prevalence of anemia at each trimester has remained stable since 1979. In 1990, 9.8%, 13.8%, and 33% of the women reported by the PNSS were anemic in the first, second, and third trimesters, respectively. Anemia in the first trimester appeared to be strongly associated with a high risk of low birth weight; this association was attenuated in later trimesters. These findings indicate the need to improve iron nutrition among low income women. Authors: Insum Kim, Dr.P.H., Daniel W. Hungerford, Dr.P.H., Ray Yip, M.D., M.P.H., Sarah A. Kuester, M.S., R.D., Colette Zyrkowski, M.P.H., R.D., Frederick L. Trowbridge, M.D., M.Sc., Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC.

References

1. CDC. CDC surveillance summaries (November 20). MMWR 1992;41(no. SS-6).

2. CDC. CDC surveillance summaries (November 27). MMWR 1992;41(no. SS-7).

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