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20,000+ Annual Foodborne Illnesses Reported, Says CDC

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A total of 1,097 foodborne disease outbreaks were reported in 2007 to the Centers for Disease Control and Prevention, according to a CDC analysis. State investigators reported 21,244 illnesses and 18 deaths as a result of these outbreaks. The report also provides the most recent data on how many illnesses were linked to specific types of foods.

“Knowing more about what types of foods and foodborne agents have caused outbreaks can help guide public health and the food industry in developing measures to effectively control and prevent infections and help people stay healthy,” said Chris Braden, acting director of the CDC’s Division of Foodborne, Waterborne and Environmental Diseases.

Despite health officials’ efforts, the cause of an outbreak—either the food or the foodborne agent responsible—often cannot be determined or confirmed. This most commonly is the case when the outbreak is small. Of 1,097 reported outbreaks in 2007, 497 (or 45 percent) confirmed that one foodborne agent was responsible and in an additional 12 outbreaks more than one foodborne agent was responsible. Thus, in more than half of the outbreaks, a foodborne agent was not identified. Norovirus was the most frequently confirmed foodborne agent (39 percent), followed by Salmonella (27 percent).

Foodborne disease outbreaks due to norovirus occur most often when infected food handlers do not wash their hands well after using the toilet; outbreaks due to salmonella occur most often when foods are contaminated with animal feces. Contaminated foods are often of animal origin, such as beef, poultry, milk, or eggs. But any food, including vegetables, may become contaminated. Thorough cooking kills Salmonella.

The report states that in the 235 outbreaks where one food commodity was identified, the largest number of illnesses listed poultry (691 illnesses), beef (667 illnesses), and leafy vegetables (590 illnesses) as the cause. The CDC tracks 17 food commodity categories.

To prevent foodborne illnesses, CDC recommends that consumers and food handlers appropriately clean, separate, cook and chill foods.

Source: CDC, August 12, 2010

World Health Organization Declares End to H1N1 Influenza Pandemic

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The World Health Organization (WHO) International Health Regulations (IHR) Emergency Committee and the WHO Director-General, Dr. Margaret Chan, today declared an end to the 2009 H1N1 influenza pandemic. This declaration was based on strong indications that influenza, worldwide, is transitioning toward seasonal patterns of transmission.

In the majority of countries, out-of-season 2009 H1N1 outbreaks are no longer being observed, and the intensity of 2009 H1N1 influenza virus transmission is lower than that reported during 2009 and early 2010. Members of the Emergency Committee further noted that the 2009 H1N1 viruses will likely continue to circulate for some years to come, taking on the behavior of a seasonal influenza virus.

This does not mean that the H1N1 virus has disappeared. Rather, it means current influenza outbreaks including those primarily caused by the 2009 H1N1 virus, show an intensity similar to that seen during seasonal epidemics. Pandemics, like the viruses that cause them, are unpredictable. WHO noted that continued vigilance is extremely important, and it is likely that the virus will continue to cause serious disease in younger age groups and pregnant women, at least in the immediate post-pandemic period.

The WHO Director-General ended the Public Health Emergency of International Concern in accordance with the International Health Regulations (2005).

Implications for United States
This is a formal WHO declaration regarding the end of the pandemic at the global level. The U.S. Public Health Emergency determination for 2009 H1N1 Influenza expired on June 23, 2010.

The only impact on the United States resulting from the WHO declaration will be a cessation in weekly reporting under the International Health Regulations (IHR) to the Pan American Health Organization and the World Health Organization. CDC has reported weekly to IHR since early in the pandemic.

There are no changes for the United States in terms of CDC’s recommendations for the upcoming influenza season and the United States is already proceeding with the understanding that the 2009 H1N1 virus is now part of seasonal influenza virus circulation.

Protecting Yourself and Others from Influenza
CDC recommends a three-step approach to fighting flu: vaccination, everyday preventive actions and the correct use of antiviral drugs if your doctor recommends them. The first and most important step in protecting against the flu is to get a flu vaccine each season.

The U.S. 2010-2011 influenza vaccine will protect against an H3N2 virus, an influenza B virus, and the 2009 H1N1 influenza virus that caused the first global pandemic in more than 40 years and resulted in substantial illness, hospitalizations and deaths. In the United States, the CDC’s Advisory Committee on Immunization Practices recently recommended that everyone 6 months of age and older be vaccinated against influenza each season. Pregnant women, young children, and anyone with underlying health conditions like asthma, diabetes and neuromuscular diseases are at especially high risk for influenza-related complications and, therefore, should be vaccinated as soon as vaccine becomes available. Vaccine manufacturers are predicting an ample supply of influenza vaccine for the upcoming 2010-2011 U.S. influenza season.

Source: CDC, August 10, 2010

U.S. Adult Obesity Rates on the Rise

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The number of states with an obesity prevalence of 30 percent or more has tripled in two years to nine states in 2009, according to a CDC Vital Signs report. In 2000, no state had an obesity prevalence of 30 percent or more. The report, “State-Specific Obesity Prevalence Among Adults – United States, 2009,” also finds no state met the nation’s Healthy People 2010 goal to lower obesity prevalence to 15 percent.

The data show a 1.1 percentage point increase—an additional 2.4 million people—in the self-reported prevalence of obesity between 2007 and 2009 among adults aged 18 and over. The report also notes the medical costs associated with obesity are high. In 2008 dollars, medical costs associated with obesity were estimated at $147 billion. People who are obese had medical costs that were $1,429 higher than those of normal weight, the report said.

“Obesity continues to be a major public health problem,” said CDC Director Thomas Frieden, M.D., M.P.H. “We need intensive, comprehensive and ongoing efforts to address obesity. If we don’t more people will get sick and die from obesity-related conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of death.”

The August Vital Signs report is based on new data from the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS contains state-level public health data and provides a way for states to monitor progress toward Healthy People goals. To assess obesity prevalence, approximately 400,000 phone survey respondents were asked to provide their height and weight, which was used to calculate their body mass index (BMI). An adult is considered obese if he or she has a BMI of 30 or above. For example, a 5-foot-4 woman who weighs 174 pounds or more, or a 5-foot-10 man who weighs 209 pounds or more has a BMI of 30, and so is considered obese.

The BRFSS obesity data are underestimates of true obesity prevalence. Research has found that both men and women often say they are taller than they actually are and women often say they weigh less than they do in telephone surveys. As a result, according to William Dietz, M.D., Ph.D., director of CDC’s Division of Nutrition, Physical Activity and Obesity, the overall BRFSS obesity prevalence estimate of 26.7 percent is 7.2 percentage points lower than the national 2007-2008 estimate of 33.9 percent (nearly 73 million people) from the National Health and Nutrition Examination Survey, for which individuals’ height and weight were measured rather than self-reported.

The BRFSS data highlight how obesity affects some populations more than others. The highest prevalence was found among non-Hispanic blacks overall, whose rate was 36.8 percent, and non-Hispanic black women, whose rate was 41.9 percent. The rate for Hispanics was 30.7 percent. The rate among all non-high school graduates was 32.9 percent. Obesity prevalence was also higher in some regions than others. The South had an obesity prevalence of 28.4 percent while the Midwest had a prevalence of 28.2 percent.

“Obesity is a complex problem that requires both personal and community action,” said Dr. Dietz. “People in all communities should be able to make healthy choices, but in order to make those choices there must be healthy choices to make. We need to change our communities into places where healthy eating and active living are the easiest path.”

90% of U.S. Adults Get Too Much Salt

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Less than 10 percent of U.S. adults limit their daily sodium intake to recommended levels, according to a new report, “Sodium Intake in Adults – United States, 2005-2006,” published today in Morbidity and Mortality Weekly Report. The report also finds that most sodium in the American diet comes from processed grains such as pizza and cookies, and meats, including poultry and luncheon meats.

According to the report, U.S. adults consume an average of 3,466 milligrams (mg) of sodium per day, more than twice the current recommended limit for most Americans. Grains provide 36.9 percent of this total, followed by dishes containing meat, poultry, and fish (27.9 percent). These two categories combined account for almost two-thirds of the daily sodium intake for Americans.

An estimated 77 percent of dietary sodium comes from processed and restaurant foods. Many of these foods, such as breads and cookies, may not even taste salty. “Sodium has become so pervasive in our food supply that it’s difficult for the vast majority of Americans to stay within recommended limits,” said Janelle Peralez Gunn, public health analyst with CDC’s Division for Heart Disease and Stroke Prevention and lead author of the report. “Public health professionals, together with food manufacturers, retailers and health care providers, must take action now to help support people’s efforts to reduce their sodium consumption.”

The 2005 Dietary Guidelines for Americans recommends that people consume less than 2,300 mg of sodium per day. Specific groups, including persons with high blood pressure, all middle-aged and older adults and all blacks, should limit intake to 1500 mg per day. These specific groups comprise nearly 70 percent of the U.S. adult population. This study found that only 9.6 percent of all participants met their applicable dietary recommendation, including 5.5 percent of the group limited to 1,500 mg per day and 18.8 percent of the 2,300 mg per day group.

The report examined data for 2005–2006 from the National Health and Nutrition Examination Survey (NHANES), an ongoing study that explores the health and nutritional status of adults and children in the United States. Researchers used information from 24-hour dietary recall and the USDA National Nutrient Database to estimate the daily sodium intake and sources of sodium intake for U.S. adults.

The findings add to a growing body of observational research studies on Americans’ excessive sodium consumption. Overconsumption of sodium can have negative health effects, including increasing average levels of blood pressure. One in three U.S. adults has high blood pressure, and an estimated 90 percent of U.S. adults will develop the disease in their lifetime. Blood pressure is a major risk factor for heart disease and stroke, the first and third leading causes of death among adults in the United States.

Source: CDC, June 24, 2010

Recreational Use of Prescription Drugs Among Teens

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Twenty percent of high school students in the United States have taken a prescription drug, such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax, without a doctor’s prescription, according to the 2009 National Youth Risk Behavior Survey (YRBS). This is the first year the survey assessed prescription drug abuse among high school students. The 2009 YRBS shows that many high school students engage in risk behaviors that are harmful to their overall health and increase their risk of disease and injury.

The Centers for Disease Control (CDC) and YRBS’s recently released issue brief, “Unintentional Drug Poisoning in the United States” highlight a serious public health problem with non-medical use of prescription drugs. The issue brief points out that drug overdose rates have risen steadily in the United States since 1999, with most of the increase due to prescription drugs.

Data from the Drug Abuse Warning Network (DAWN), operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), estimate that in 2008 people 12-20 years old accounted for an estimated 141,417 (14.5 percent) of the 971,914 emergency department visits for nonmedical use of pharmaceuticals. These numbers do not include suicide attempts.

“Our Nation faces many public health threats that deserve our immediate attention. Among them, there is the pressing reality of drug overdoses. Teens and others have a false assumption that prescription drugs are a safer high,” said Grant Baldwin, PhD, MPH, Director of CDC’s Injury Center Division of Unintentional Injury Prevention. “These data and that from other sources show us that prescription drug misuse is a significant problem in both adolescents and adults.”

The CDC recommendations in the issue brief are based on promising interventions and expert opinion to help health care providers, state and federal agencies, as well as private insurance providers and pharmacy benefit managers, to better understand the impact and cost of unintentional poisoning. CDC continues to respond to this problem through surveillance activities, epidemiologic research, and evaluation of interventions with the greatest promise of creating a public health impact.

Source: CDC, June 3, 2010

Arthritis Impact on African-Americans and Hispanics

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Arthritis causes more pain and limitations for African-Americans and Hispanics than for whites, according to a study released today by the Centers for Disease Control and Prevention.

African-Americans were 17 percent less likely to report having arthritis than whites, and Hispanics were 46 percent less likely to report the condition than whites, the study said. However, African-Americans and Hispanics with arthritis were almost twice as likely to report severe joint pain and work limitations attributed to their arthritis when compared to whites, it said.

The study, “Difference in the Prevalence and Impact of Arthritis among Racial/Ethnic Groups,” was published in the journal Preventing Chronic Disease.

Arthritis is the leading cause of disability in the United States, affecting 20% of adults. It interferes with work and other daily activities and can complicate the management of other chronic diseases. Arthritis encompasses more than 100 diseases and conditions that affect joints and other connective tissue.

The reason for the racial and ethnic differences, while unknown, may result from a lack of access to health care, language barriers and cultural differences, the report says.

“We must address these stark differences in arthritis impact by using what we know,” said Jennifer Hootman, an epidemiologist for the CDC National Center for Chronic Disease Prevention and Health Promotion and co-author of the report. “We can educate those with arthritis about increasing physical activity and self-management and reducing obesity, especially those in groups bearing a disproportionate burden from arthritis.”

The data, collected from the CDC National Health Interview Survey, are the first to estimate the national prevalence of arthritis and assess its impact among smaller racial and ethnic groups that are usually grouped together when reporting health statistics.

Source: CDC, April 15, 2010

Generic Versions of Cozaar and Hyzaar Tablets Approved for Hypertension Treatment

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The U.S. Food and Drug Administration approved today the first generic versions of two drugs used for the treatment of hypertension. Losartan potassium tablets and losartan potassium and hydrochlorothiazide tablets (a combination drug) are the generic equivalents of Cozaar and Hyzaar tablets, respectively.

Cozaar and Hyzaar tablets are widely-used antihypertensive drugs. Both generic losartan products will carry the same safety warnings as their brand counterparts. These warnings include a boxed warning against the use of these products during the second and third trimesters of pregnancy.

Losartan potassium tablets are approved in 25 milligram, 50 mg, and 100 mg strengths, and Losartan potassium and hydrochlorothiazide tablets are approved in 50 mg/12.5 mg, 100mg/12.5 mg, and 100 mg/25 mg strengths. Both products are manufactured by TEVA Pharmaceuticals USA in North Wales, Pa.

In related actions, the FDA also approved applications from several other companies for losartan potassium and hydrochlorothiazide tablets for the 100 mg/12.5 mg strength only. These companies include Mylan Pharmaceuticals Inc., Roxane Laboratories Inc., and Torrent Pharmaceuticals Ltd.

Source: FDA, April 7, 2010

New OxyContin Formulation Designed to Discourage Abuse of the Drug

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The U.S. Food and Drug Administration today approved a new formulation of the controlled-release drug OxyContin that has been designed to help discourage misuse and abuse of the medication.

OxyContin is made to slowly release the potent opioid oxycodone to treat patients who require a continuous, around-the-clock opioid analgesic for management of their moderate to severe pain for an extended period of time. Because of its controlled-release properties, each OxyContin tablet contains a large quantity of oxycodone, which allows patients to take their drug less often. However, people intent on abusing the previous formulation have been able to release high levels of oxycodone all at once, which can result in a fatal overdose and contributes to high rates of OxyContin abuse.

The reformulated OxyContin is intended to prevent the opioid medication from being cut, broken, chewed, crushed or dissolved to release more medication. The new formulation may be an improvement that may result in less risk of overdose due to tampering, and will likely result in less abuse by snorting or injection; but it still can be abused or misused by simply ingesting larger doses than are recommended.

“Although this new formulation of OxyContin may provide only an incremental advantage over the current version of the drug, it is still a step in the right direction,” said Bob Rappaport, M.D., director of the Division of Anesthesia and Analgesia Products in the FDA’s Center for Drug Evaluation and Research.

“As with all opioids, safety is an important consideration,” he said. “Prescribers and patients need to know that its tamper-resistant properties are limited and need to carefully weigh the benefits and risks of using this medication to treat pain.”

According to the U.S. Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, approximately half a million people used OxyContin non-medically for the first time in 2008.

The manufacturer of OxyContin, Purdue Pharma L.P., will be required to conduct a postmarket study to collect data on the extent to which the new formulation reduces abuse and misuse of this opioid. The FDA is also requiring a REMS (Risk Evaluation and Mitigation Strategy) that will include the issuance of a Medication Guide to patients and a requirement for prescriber education regarding the appropriate use of opioid analgesics in the treatment of pain.

Purdue Pharma is based in Stamford, Conn.

Asclera Approved by FDA for Varicose Vein Treatment

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The U.S. Food and Drug Administration today approved Asclera (polidocanol) injection for the treatment of small types of abnormally swollen or twisted veins called varicose veins.

Although they usually occur in the legs, varicose veins also can form in other parts of the body. Factors such as genetics, age, female gender, pregnancy, obesity, and prolonged periods of standing may increase the risk for varicose veins.

“Varicose veins are a common condition,” said Norman Stockbridge, M.D., Ph.D., director of the Division of Cardiovascular and Renal Products at the FDA’s Center for Drug Evaluation and Research. “Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance.”

Asclera is approved to close spider veins (tiny varicose veins less than 1 millimeter in diameter) and reticular veins (those that are 1 to 3 millimeters in diameter). Asclera acts by damaging the cell lining of blood vessels. This causes the blood vessel to close, and it is eventually replaced by other types of tissue.

Common adverse reactions to Asclera include leakage and collection of blood from damaged blood vessels at the injection site (hematoma), bruising, irritation, discoloration, and pain at the injection site.

Asclera is distributed by BioForm Medical Inc. of Franksville, Wis., and manufactured by Chemische Fabrik Kreussler & Co. of Wiesbaden, Germany.

Source: FDA, March 30, 2010

Kids with Sickle Cell Disease More Likely to Have Physical and Developmental Health Problems

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The first national estimate on the health status of children with sickle cell disease revealed that black children with sickle cell disease are more likely to have intellectual disabilities, hearing deficits, and frequent severe headaches or migraines than black children without sickle cell disease. The study by the Centers for Disease Control and Prevention (CDC), “Health Status and Healthcare Use in a National Sample of Children with Sickle Cell Disease,” was published in the American Journal of Preventive Medicine.

The study found that black children with sickle cell disease are four times more likely to have fair or poor health status, twice as likely to have recently visited a mental health professional and have received special educational or early intervention services more often compared with black children without sickle cell disease.

Sickle cell disease is a group of red blood cell disorders that is inherited, passed from parents to children. In sickle cell disease, the red blood cells become hard and sticky, and take on a sickle shape. When the C-shaped cells travel through small blood vessels, they clog the vessels and can block blood flow. In addition, the sickled cells die earlier than normal blood cells, which creates a constant shortage of red blood cells.

“In the United States, sickle cell disease is one of the most common genetic disorders; more than 20 percent of children with SCD had recently visited a health care provider such as an optometrist or an ophthalmologist, and had more than one visit to the emergency department in the past year,” said Sheree Boulet, DrPH, with CDC’s Division of Blood Disorders. “The findings of this study emphasize the importance of screening children with sickle cell disease for thinking ability, hearing, and vision problems.”

Further, despite the increased use of health care services, the data showed that more parents indicated that they could not get an appointment for their child soon enough (10.5 percent, compared to 3.9 percent of parents whose children did not have SCD), reported waiting too long in the doctor’s office (8.7 percent versus 4 percent), and could not get through to their doctor on the telephone (7.5 percent versus 1.8 percent).

“This study gives a better insight into the types of disabilities children with sickle cell disease have and can help health care providers plan comprehensive treatments for children with the disease,” said Dr. Boulet.

The study analyzed data from the 1997–2005 National Health Interview Surveys (NHIS) to describe health status and health services use among black children 0-17 years of age with SCD.  The NHIS has monitored the health of the nation since 1957; it is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC). NHIS data on a broad range of health topics are collected through personal household interviews.

Source: Centers for Disease Control (CDC), March 23, 2010