hicn medical newsletter part cut here volume number april health info com network medical newsletter editor david dodell d m d north nd street suite scottsdale arizona usa telephone fax compilation copyright by david dodell d m d all rights reserved license is hereby granted to republish on electronic media for which no fees are charged so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions the health info com network newsletter is distributed biweekly articles on a medical nature are welcomed if you have an article please contact the editor for information on how to submit it if you are interested in joining the automated distribution system please contact the editor e mail address editor internet david stat com fidonet bitnet atw h asuacad listserv mednews asuacad bitnet or internet mednews asuvm inre asu edu anonymous ftp vm nodak edu notification list hicn notify request stat com fax delivery contact editor for information t a b l e o f c o n t e n t s comments news from the editor ocr scanner news centers for disease control and prevention mmwr april emerging infectious diseases outbreak of e coli infections from hamburgers use of smokeless tobacoo among adults gonorrhea impact of adult safety belt use on children less than years age publication of cdc surveillance summaries clinical research news high tech assisted reproductive technologies articles low levels airborne particles linked to serious asthma attacks nih consensus development conference on melanoma national cancer insitute designated cancer centers general announcments uci medical education software repository aids news summaries aids daily summary april to april aids hiv articles first hiv vaccine trial begins in hiv infected children new evidence that the hiv can cause disease independently clinical consultation telephone service for aids hicnet medical newsletter page i volume number april comments news from the editor i would like to continue to thank everyone who has sent in a donation for the mednews ocr scanner fund we have reached our goal a hewlett packard scanjet iip was purchased this week thank you to the following individuals whose contributions i just received john sorenson carol sigelman carla moore barbara moose judith schrier again thank you to all who gave i have been using wordscan plus for the past couple of weeks and would like to review the product wordscan plus is a product of calera recognition systems it runs under windows and supports that accufont technology of the hewlett packard scanners when initially bringing up the software it lets you select several options text graphics input source ie scanner fax file disk file automatic versus manual decomposition of the scanned image i like manual decomposition since the software then lets me select which parts of the document i would like scanned and in what order once an image is scanned you can bring up the pop up image verification the software gives you two errors at this point blue which are words that were converted reliability but do not match anything in the built in dictionary yellow shade which are words that wordscan plus doesn t think it converted correctly at all i have found that the software should give itself more credit it is usually correct instead of wrong if a word is shaded blue you can add it to your personal dictionary the only problem is the personal dictionary will only handle about words i find this to be very limited considering how many medical terms are not in a normal dictionary after a document is converted you can save it in a multitude of word processor formats also any images that were captured can be stored in a seperate tiff or pcx file format i was extremely impressed on the percent accuracy for fax files i use hicnet medical newsletter page volume number april an intel satisfaxtion card which stores incoming faxs in a pcx dcx format while most of my faxes were received in standard mode x dpi the accuracy of wordscan plus was excellent overall a very impressive product the only fault i could find is the limitations of the size of the user dictionary specialized words is just too small if anyone has any specific questions please do not hesitate to send me email hicnet medical newsletter page volume number april centers for disease control and prevention mmwr emerging infectious diseases source mmwr date apr introduction despite predictions earlier this century that infectious diseases would soon be eliminated as a public health problem infectious diseases remain the major cause of death worldwide and a leading cause of illness and death in the united states since the early s the u s public health system has been challenged by a myriad of newly identified pathogens and syndromes e g escherichia coli o h hepatitis c virus human immunodeficiency virus legionnaires disease lyme disease and toxic shock syndrome the incidences of many diseases widely presumed to be under control such as cholera malaria and tuberculosis tb have increased in many areas furthermore control and prevention of infectious diseases are undermined by drug resistance in conditions such as gonorrhea malaria pneumococcal disease salmonellosis shigellosis tb and staphylococcal infections emerging infections place a disproportionate burden on immunocompromised persons those in institutional settings e g hospitals and child day care centers and minority and underserved populations the substantial economic burden of emerging infections on the u s health care system could be reduced by more effective surveillance systems and targeted control and prevention programs this issue of mmwr introduces a new series emerging infectious diseases future articles will address these diseases as well as surveillance control and prevention efforts by health care providers and public health officials this first article updates the ongoing investigation of an outbreak of e coli o h in the western united states references burnet m natural history of infectious disease cambridge england cambridge university press kunin cm resistance to antimicrobial drugs a worldwide calamity ann intern med lederberg j shope re oaks sc jr eds emerging infections microbial threats to health in the united states washington dc national academy press hicnet medical newsletter page volume number april cdc preliminary report foodborne outbreak of escherichia coli o h infections from hamburgers western united states mmwr hicnet medical newsletter page volume number april update multistate outbreak of escherichia coli o h infections from hamburgers western united states source mmwr date apr from november through february more than laboratory confirmed infections with e coli o h and four associated deaths occurred in four states washington idaho california and nevada this report summarizes the findings from an ongoing investigation that identified a multistate outbreak resulting from consumption of hamburgers from one restaurant chain washington on january a physician reported to the washington department of health a cluster of children with hemolytic uremic syndrome hus and an increase in emergency room visits for bloody diarrhea during january a case control study comparing of the first cases of bloody diarrhea or postdiarrheal hus identified with age and neighborhood matched controls implicated eating at chain a restaurants during the week before symptom onset matched odds ratio or undefined lower confidence limit on january a multistate recall of unused hamburger patties from chain a restaurants was initiated as a result of publicity and case finding efforts during january february patients with bloody diarrhea or hus were reported to the state health department a total of persons had illnesses meeting the case definition of culture confirmed e coli o h infection or postdiarrheal hus figure of the persons had close contact with a person with confirmed e coli o h infection during the week preceding onset of symptoms of the remaining persons reported eating in a chain a restaurant during the days preceding onset of symptoms of the patients who recalled what they ate in a chain a restaurant reported eating a regular sized hamburger patty onsets of illness peaked from january through january of the casepatients were hospitalized developed hus and three died the median age of patients was years range years idaho following the outbreak report from washington the division of health idaho department of health and welfare identified persons with culture confirmed e coli o h infection with illness onset dates from december through february figure a four persons were hospitalized one developed hus during the week preceding illness onset had eaten at a chain a restaurant california in late december the san diego county department of health services was notified of a child with e coli o h infection who subsequently died active surveillance and record review then identified eight other persons with e coli o h infections or hus from mid november through mid january four of the nine reportedly had recently eaten at a chain a restaurant and hicnet medical newsletter page volume number april four at a chain b restaurant in san diego after the washington outbreak was reported reviews of medical records at five hospitals revealed an overall increase in visits or admissions for diarrhea during december and january compared with the same period year earlier a case was defined as postdiarrheal hus bloody diarrhea that was culture negative or not cultured or any diarrheal illness in which stool culture yielded e coli o h with onset from november through january illnesses of patients met the case definition figure b the outbreak strain was identified in stool specimens of six patients fourteen persons were hospitalized seven developed hus and one child died the median age of case patients was years range years a case control study of the first case patients identified and age and sex matched community controls implicated eating at a chain a restaurant in san diego matched or confidence interval ci a study comparing case patients who ate at chain a restaurants with well meal companions implicated regular sized hamburger patties matched or undefined lower confidence limit chain b was not statistically associated with illness nevada on january after receiving a report of a child with hus who had eaten at a local chain a restaurant the clark county las vegas health district issued a press release requesting that persons with recent bloody diarrhea contact the health department a case was defined as postdiarrheal hus bloody diarrhea that was culture negative or not cultured or any diarrheal illness with a stool culture yielding the washington strain of e coli o h with onset from december through february because local laboratories were not using sorbitol macconkey smac medium to screen stools for e coli o h this organism was not identified in any patient after smac medium was distributed the outbreak strain was detected in the stool of one patient days after illness onset of persons whose illnesses met the case definition figure c nine were hospitalized three developed hus the median age was years range years analysis of the first patients identified and age and sex matched community controls implicated eating at a chain a restaurant during the week preceding illness onset matched or undefined lower confidence limit a case control study using well meal companions of case patients also implicated eating hamburgers at chain a matched or ci other investigation findings during the outbreak chain a restaurants in washington linked with cases primarily were serving regular sized hamburger patties produced on november some of the same meat was used in jumbo patties produced on november the outbreak strain of e coli o h was isolated from lots of patties produced on those two dates these lots had been distributed to restaurants in all states where illness occurred approximately of the implicated patties were recovered by the recall a meat traceback by a cdc team identified five slaughter plants in the united states and one in canada as the likely sources of carcasses used in the hicnet medical newsletter page volume number april contaminated lots of meat and identified potential control points for reducing the likelihood of contamination the animals slaughtered in domestic slaughter plants were traced to farms and auctions in six western states no one slaughter plant or farm was identified as the source further investigation of cases related to secondary transmission in families and child day care settings is ongoing reported by m davis dvm c osaki msph seattle king county dept of public health d gordon ms mw hinds md snohomish health district everett k mottram c winegar mph tacoma pierce county health dept ed avner md pi tarr md dept of pediatrics d jardine md depts of anesthesiology and pediatrics univ of washington school of medicine and children s hospital and medical center seattle m goldoft md b bartleson mph j lewis jm kobayashi md state epidemiologist washington dept of health g billman md j bradley md children s hospital san diego s hunt p tanner res m ginsberg md san diego county dept of health svcs l barrett dvm sb werner md gw rutherford iii md state epidemiologist california dept of health svcs rw jue central district health dept boise h root southwest district health dept caldwell d brothers ma rl chehey ms rh hudson phd div of health idaho state public health laboratory fr dixon md state epidemiologist div of health idaho dept of health and welfare dj maxson environmental epidemiology program l empey pa o ravenholt md vh ueckart dvm clark county health district las vegas a disalvo md nevada state public health laboratory ds kwalick md r salcido mph d brus dvm state epidemiologist div of health nevada state dept of human resources center for food safety and applied nutrition food and drug administration food safety inspection svc animal and plant health inspection svc us dept of agriculture div of field epidemiology epidemiology program office enteric diseases br div of bacterial and mycotic diseases national center for infectious diseases cdc editorial note e coli o h is a pathogenic gram negative bacterium first identified as a cause of illness in during an outbreak of severe bloody diarrhea traced to contaminated hamburgers this pathogen has since emerged as an important cause of both bloody diarrhea and hus the most common cause of acute renal failure in children outbreak investigations have linked most cases with the consumption of undercooked ground beef although other food vehicles including roast beef raw milk and apple cider also have been implicated preliminary data from a cdc year nationwide multicenter study revealed that when stools were routinely cultured for e coli o h that organism was isolated more frequently than shigella in four of participating hospitals and was isolated from of all bloody stools a higher rate than for any other pathogen infection with e coli o h often is not recognized because most clinical laboratories do not routinely culture stools for this organism on hicnet medical newsletter page volume number april smac medium and many clinicians are unaware of the spectrum of illnesses associated with infection the usual clinical manifestations are diarrhea often bloody and abdominal cramps fever is infrequent younger age groups and the elderly are at highest risk for clinical manifestations and complications illness usually resolves after days but of patients develop hus which is characterized by hemolytic anemia thrombocytopenia renal failure and a death rate of this report illustrates the difficulties in recognizing community outbreaks of e coli o h in the absence of routine surveillance despite the magnitude of this outbreak the problem may not have been recognized in three states if the epidemiologic link had not been established in washington clinical laboratories should routinely culture stool specimens from persons with bloody diarrhea or hus for e coli o h using smac agar when infections with e coli o h are identified they should be reported to local health departments for further evaluation and if necessary public health action to prevent further cases e coli o h lives in the intestines of healthy cattle and can contaminate meat during slaughter cdc is collaborating with the u s department of agriculture s food safety inspection service to identify critical control points in processing as a component of a program to reduce the likelihood of pathogens such as e coli o h entering the meat supply because slaughtering practices can result in contamination of raw meat with pathogens and because the process of grinding beef may transfer pathogens from the surface of the meat to the interior ground beef is likely to be internally contaminated the optimal food protection practice is to cook ground beef thoroughly until the interior is no longer pink and the juices are clear in this outbreak undercooking of hamburger patties likely played an important role the food and drug administration fda has issued interim recommendations to increase the internal temperature for cooked hamburgers to f c fda personal communication regulatory actions stimulated by the outbreak described in this report and the recovery of thousands of contaminated patties before they could be consumed emphasize the value of rapid public health investigations of outbreaks the public health impact and increasing frequency of isolation of this pathogen underscore the need for improved surveillance for infections caused by e coli o h and for hus to better define the epidemiology of e coli o h references cdc preliminary report foodborne outbreak of escherichia coli o h infections from hamburgers western united states mmwr riley lw remis rs helgerson sd et al hemorrhagic colitis associated with a rare escherichia coli serotype n engl j med hicnet medical newsletter page volume number april griffin pm tauxe rv the epidemiology of infections caused by escherichia coli o h other enterohemorrhagic e coli and the associated hemolytic uremic syndrome epidemiol rev griffin pm ostroff sm tauxe rv et al illnesses associated with escherichia coli o h infections a broad clinical spectrum ann intern med march sb ratnam s latex agglutination test hicnet medical newsletter page volume number april use of smokeless tobacco among adults united states source mmwr date apr consumption of moist snuff and other smokeless tobacco products in the united states almost tripled from through long term use of smokeless tobacco is associated with nicotine addiction and increased risk of oral cancer the incidence of which could increase if young persons who currently use smokeless tobacco continue to use these products frequently to monitor trends in the prevalence of use of smokeless tobacco products cdc s national health interview survey health promotion and disease prevention supplement nhis hpdp collected information on snuff and chewing tobacco use and smoking from a representative sample of the u s civilian noninstitutionalized population aged greater than or equal to years this report summarizes findings from this survey the nhis hpdp supplement asked have you used snuff at least times in your entire life and do you use snuff now similar questions were asked about chewing tobacco use and cigarette smoking current users of smokeless tobacco were defined as those who reported snuff or chewing tobacco use at least times and who reported using snuff or chewing tobacco at the time of the interview former users were defined as those who reported having used snuff or chewing tobacco at least times and not using either at the time of the interview ever users of smokeless tobacco included current and former users current smokers were defined as those who reported smoking at least cigarettes and who were currently smoking and former smokers as those who reported having smoked at least cigarettes and who were not smoking now ever smokers included current and former smokers data on smokeless tobacco use were available for persons aged greater than or equal to years and were adjusted for nonresponse and weighted to provide national estimates confidence intervals cis were calculated by using standard errors generated by the software for survey data analysis sudaan in an estimated million u s adults were current users of smokeless tobacco including million men and women for all categories of comparison the prevalence of smokeless tobacco use was substantially higher among men for men the prevalence of use was highest among those aged years table for women the prevalence was highest among those aged greater than or equal to years the prevalence of smokeless tobacco use among men was highest among american indians alaskan natives and whites the prevalence among women was highest among american indians alaskan natives and blacks among both men and women prevalence of smokeless tobacco use declined with increasing education prevalence was substantially higher among residents of the southern united states and in rural areas although the prevalence of smokeless tobacco use was higher among hicnet medical newsletter page volume number april men and women below the poverty level this difference was significant only for women p less than table among men the prevalence of current use of snuff was highest among those aged years but varied considerably by age the prevalence of use of chewing tobacco was more evenly distributed by age group table although women rarely used smokeless tobacco the prevalence of snuff use was highest among those aged greater than or equal to years an estimated million ci adults reported being former smokeless tobacco users among ever users the proportion who were former smokeless tobacco users was ci among persons aged years the proportion of former users was lower among snuff users ci than among chewing tobacco users ci among persons aged years the proportion of former users was similar for snuff ci and chewing tobacco ci among current users of smokeless tobacco ci currently smoked ci formerly smoked and ci never smoked in comparison among current smokers ci were current users of smokeless tobacco daily use of smokeless tobacco was more common among snuff users ci than among chewing tobacco users ci reported by 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 use of smokeless tobacco was highest among young males adolescent and young adult males in particular are the target of marketing strategies by tobacco companies that link smokeless tobacco with athletic performance and virility use of oral snuff has risen markedly among professional baseball players encouraging this behavior among adolescent and young adult males and increasing their risk for nicotine addiction oral cancer and other mouth disorders differences in the prevalence of smokeless tobacco use among racial ethnic groups may be influenced by differences in educational levels and socioeconomic status as well as social and cultural phenomena that require further explanation for example targeted marketing practices may play a role in maintaining or increasing prevalence among some groups and affecting the differential initiation of smokeless tobacco use by young persons in this report one concern is that nearly one fourth of current smokeless tobacco users also smoke cigarettes in the nhis hpdp the prevalence of cigarette smoking was higher among former smokeless tobacco users than among current and never smokeless tobacco users in a previous study among college students of current smokeless tobacco users smoked hicnet medical newsletter page volume number april occasionally in addition approximately of adults who formerly smoked reported substituting other tobacco products for cigarettes in an effort to stop smoking health care providers should recognize the potential health implications of concurrent smokeless tobacco and cigarette use the national health objectives for the year have established special population target groups for the reduction of the prevalence of smokeless tobacco use including males aged years to no more than by the year objective and american indian alaskan native youth to no more than by the year objective a strategies to lower the prevalence of smokeless tobacco use include continued monitoring of smokeless tobacco use integrating smoking and smokeless tobacco control efforts enforcing laws that restrict minors access to tobacco making excise taxes commensurate with those on cigarettes encouraging health care providers to routinely provide cessation advice and follow up providing school based prevention and cessation interventions and adopting policies that prohibit tobacco use on school property and at school sponsored events references office of evaluations and inspections spit tobacco and youth washington dc us department of health and human services office of the inspector general dhhs publication no oei national institutes of health the health consequences of using smokeless tobacco a report of the advisory committee to the surgeon general bethesda maryland us department of health and human services public health service dhhs publication no nih shah bv software for survey data analysis sudaan version software documentation research triangle park north carolina research triangle institute connolly gn orleans ct blum a snuffing tobacco out of sport am j public health national cancer institute smokeless tobacco or health an international perspective bethesda maryland us department of health and human services public health service national institutes of health dhhs publication no nih foreyt jp jackson as squires wg hartung gh murray td gotto am psychological profile of college students who use smokeless tobacco addict behav glover ed laflin m edwards sw age of initiation and switching patterns hicnet medical newsletter page volume number april between smokeless tobacco and cigarettes among college students in the united states am j public health cdc tobacco use in methods and tabulations from adult use of tobacco survey rockville maryland us department of health and human services public health service cdc dhhs publication no om public health service healthy people national health promotion and disease prevention objectives washington dc us department of health and human services public health service dhhs publication no phs end of part internet david stat com fax bitnet atw h asuacad fidonet amateur packet ax wb tpy wb tpy az usa na
