Epidemiologic Responses to Anthrax Outbreaks: A Review of Field Investigations, 1950–2001

We used unpublished reports, published manuscripts, and communication with investigators to identify and summarize 49 anthrax-related epidemiologic field investigations conducted by the Centers for Disease Control and Prevention from 1950 to August 2001. Of 41 investigations in which Bacillus anthracis caused human or animal disease, 24 were in agricultural settings, 11 in textile mills, and 6 in other settings. Among the other investigations, two focused on building decontamination, one was a response to bioterrorism threats, and five involved other causes. Knowledge gained in these investigations helped guide the public health response to the October 2001 intentional release of B. anthracis, especially by addressing the management of anthrax threats, prevention of occupational anthrax, use of antibiotic prophylaxis in exposed persons, use of vaccination, spread of B. anthracis spores in aerosols, clinical diagnostic and laboratory confirmation methods, techniques for environmental sampling of exposed surfaces, and methods for decontaminating buildings

Measles eradication: recommendations from a meeting cosponsored by the World Health Organization, the Pan American Health Organization, and CDC

"Recent successes in interrupting indigenous transmission of measles virus in the Americas and in the United Kingdom prompted the World Health Organization (WHO), Pan American Health Organization (PAHO), and CDC to convene a meeting in July, 1996 to consider the feasibility of global measles eradication. Presentations at the meeting included an overview of global measles control and elimination efforts; detailed reviews of successful measles elimination efforts in Latin America, the English-speaking Caribbean, Canada, and the United States; surveillance for clinical disease; laboratory tools for antibody detection and virus identification; and other factors that might influence the feasibility of disease eradication. With this background information, meeting organizers asked participants to address five questions: 1) Is global measles eradication feasible? 2) Is measles eradication feasible with current vaccines? 3) What are the appropriate vaccination strategies for measles eradication? 4) How should surveillance for measles be carried out? 5) What role should outbreak control play in the strategy to eliminate measles? Participants agreed that measles eradication is technically feasible with available vaccines and recommended adoption of the goal of global eradication with a target date during 2005-2010, with the proviso that measles eradication efforts should not interfere with poliomyelitis eradication but should build on the successes of the global Poliomyelitis Eradication Initiative. Although existing vaccines are adequate for eradication, vaccination strategies that rely on administration of a single dose of vaccine are not. In the Americas, sustained interruption of indigenous measles virus transmission has been achieved through a three-tiered vaccination strategy that includes a) "catch-up" vaccination of all persons aged 1-14 years, regardless of disease history or vaccination status; b) "keep-up" vaccination of > or = 90% of children in each successive birth cohort at age 12 months and c) "follow-up" campaigns designed to vaccinate all persons within a specific age range whenever the number of susceptible persons in the preschool-aged population approximates the size of a typical birth cohort (in practice, every 3-5 years). In other regions, different strategies may be optimal. Surveillance, a critical component of any strategy to eliminate or eradicate measles, has two functions: to assess the effectiveness of the measles elimination strategy and to detect circulation of measles virus in a population. Systematic surveillance based on clinical diagnosis should be implemented early in any measles elimination program. In countries attempting to eliminate indigenous measles, all isolated cases of measles and at least one case in each chain of transmission should be confirmed by laboratory tests. Specimens for virus isolation (e.g., urine, nasopharyngeal swabs, or blood) should be collected in conjunction with field investigations. Vaccination campaigns generally have not proved to be effective responses to measles outbreaks. Outbreaks should be treated as opportunities to reinforce surveillance and to identify measures to prevent future outbreaks. The major obstacles to measles eradication are not technical but perceptual, political, and financial. Measles is often mistakenly perceived as a mild illness. This misperception, which is particularly prevalent in industrialized countries, can inhibit the development of public and political support for the allocation of resources required for an effective elimination effort. The disease burden imposed by measles should be documented, particularly in industrialized countries, so that this information can be used to educate parents, medical practitioners, public health workers, and political leaders about the benefits of measles eradication." - p. 1Cover title.June 13, 1997."This report was prepared by the staffs of the following organizations: Expanded Programme on Immunization, World Health Organization; Special Program for Vaccines and Immunization, Pan American Health Organization; National Immunization Program, Centers for Disease Control and Prevention; Task Force for Child Survival and Development." - p. iiIncludes bibliographical references (p. 19-20)

Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine : recommendations of the Advisory Committee on Immunization Practices (ACIP)

On June 10, 2005, a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) formulated for use in adults and adolescents was licensed in the United States for persons aged 11--64 years (ADACEL\uae, manufactured by sanofi pasteur, Toronto, Ontario, Canada). Prelicensure studies demonstrated safety and efficacy, inferred through immunogenicity, against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adults. To reduce pertussis morbidity among adults and maintain the standard of care for tetanus and diphtheria prevention and to reduce the transmission of pertussis to infants and in health-care settings, the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) adults aged 19--64 years should receive a single dose of Tdap to replace tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their last dose of Td >10 years earlier and they have not previously received Tdap; 2) intervals shorter than 10 years since the last Td may be used for booster protection against pertussis; 3) adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and health-care personnel) should receive a single dose of Tdap to reduce the risk for transmitting pertussis. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. When possible, women should receive Tdap before becoming pregnant. Women who have not previously received Tdap should receive a dose of Tdap in the immediate postpartum period; 4) health-care personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap. An interval as short as 2 years from the last dose of Td is recommended; shorter intervals may be used. These recommendations for use of Tdap in health-care personnel are supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC). This statement 1) reviews pertussis, tetanus and diphtheria vaccination policy in the United States; 2) describes the clinical features and epidemiology of pertussis among adults; 3) summarizes the immunogenicity, efficacy, and safety data of Tdap; and 4) presents recommendations for the use of Tdap among adults aged 19--64 years.Introduction -- Pertussis Vaccination Policy -- Objectives of Adult Pertussis Vaccination Policy -- -- Background: Pertussis -- General Characteristics -- Clinical Features and Morbidity Among Adults with Pertussis -- Infant Pertussis and Transmission to Infants -- Pertussis Diagnosis -- Burden of Pertussis Among Adults -- -- Background: Tetanus and Diphtheria -- Tetanus -- Diphtheria -- -- Adult Acellular Pertussis Vaccine Combined with Tetanus and Diphtheria Toxoids -- ADACEL\uae -- -- Safety Considerations for Adult Vaccination with Tdap -- Spacing and Administration Sequence of Vaccines Containing Tetanus Toxoid, Diphtheria Toxoid, and Pertussis Antigens -- Neurologic and Systemic Events Associated with Vaccines with Pertussis Components or Tetanus Toxoid-Containing Vaccines -- -- Economic Considerations for Adult Tdap Use -- Economic Burden -- -- Implementation of Adult Tdap Recommendations -- Routine Adult Tdap Vaccination -- Vaccination of Adults in Contact with Infants -- Vaccination of Pregnant Women -- -- Pertussis Among Health-Care Personnel -- -- Recommendations -- Routine Tdap Vaccination -- Contraindications and Precautions for Use of Tdap -- Special Situations for Tdap Use -- Reporting of Adverse Events After Vaccination -- Vaccine Injury Compensation -- Areas of Future Research Related to Tdap and Adults -- -- Acknowledgments -- References -- Appendix A. Summary of Recommendations for Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) Use Among Adults -- Appendix B. CDC and Council of State and Territorial Epidemiologists (CSTE) Pertussis Case Definition -- Appendix C. Abbreviations Used in This Reportprepared by Katrina Kretsinger ... [et al.]"The material in this report originated in the National Center for Immunization and Respiratory Diseases (proposed), Anne Schuchat, MD, Director; Division of Bacterial Diseases (proposed), Alison Mawle, PhD, (Acting) Director, and the Office of the Chief Science Officer, Tanja Popovic, MD, (Acting) Chief Science Officer; and Immunization Safety Office, Robert Davis, MD, Director.Includes bibliographical references (p. 27-33).Infectious DiseasePrevention and ControlCurrentACIPJCSmith1/13/201

Smallpox

"Every site that ships smallpox vaccines and their diluents should have its own standard operating procedures (SOPs), which describe procedures, training, supervision and record keeping to ensure continuous quality assurance year after year. In order to help you develop your procedures, the National Immunization Program of the Centers for Disease Control and Prevention has prepared the following guidelines for smallpox vaccine packing and shipping. These guidelines are based in part on CDC's research on different shipping and handling methods under strenuous test conditions. These guidelines are not intended to be rules and regulations. They are suggestions written primarily for personnel who pack and ship vaccines. "Mode of access: Internet from the CDC web site. Address as of 2/23/2007: http://www.bt.cdc.gov/agent/smallpox/vaccination/pdf/packing-shipping.pdf; current access is available via PURL

Surveillance guidelines for smallpox vaccine (vaccinia) adverse reactions

"CDC and the U.S. Food and Drug Administration rely on state and local health departments, health-care providers, and the public to report the occurrence of adverse events after vaccination to the Vaccine Adverse Event Reporting System. With such data, trends can be accurately monitored, unusual occurrences of adverse events can be detected, and the safety of vaccination intervention activities can be evaluated. On January 24, 2003, the U.S. Department of Health and Human Services (DHHS) implemented a preparedness program in which smallpox (vaccinia) vaccine was administered to federal, state, and local volunteers who might be first responders during a biologic terrorism event. As part of the DHHS Smallpox Preparedness and Response Program, CDC in consultation with experts, established surveillance case definitions for adverse events after smallpox vaccination. Adverse reactions after smallpox vaccination identified during the 1960s surveillance activities were classified on the basis of clinical description and included eczema vaccinatum; fetal vaccinia; generalized vaccinia; accidental autoinoculation, nonocular; ocular vaccinia; progressive vaccinia; erythema multiforme major; postvaccinial encephalitis or encephalomyelitis; and pyogenic infection of the vaccination site. This report provides uniform criteria used for the surveillance case definition and classification for these previously recognized adverse reactions used during the DHHS Smallpox Preparedness and Response Program. Inadvertent inoculation was changed to more precisely describe this event as inadvertent autoinoculation and contact transmission, nonocular and ocular vaccinia. Pyogenic infection also was renamed superinfection of the vaccination site or regional lymph nodes. Finally, case definitions were developed for a new cardiac adverse reaction (myo/pericarditis) and for a cardiac adverse event (dilated cardiomyopathy) and are included in this report. The smallpox vaccine surveillance case definitions presented in the report can be used in future vaccination programs to ensure uniform reporting guidelines and case classification." - p. 1Introduction -- -- Reporting Guidelines -- -- Case Definition and Classification -- Localized Reactions -- Unintentional Transfer of Vaccinia Virus -- Diffuse Dermatologic Complications -- Progressive Vaccinia -- Rare Reactions -- Cardiac -- -- Case Classification -- Vaccinia Laboratory Diagnostics -- Surveillance Results and Outcome -- Conclusions -- Referencesprepared by Christine Casey, Claudia Vellozzi, Gina T. Mootrey, Louisa E. Chapman, Mary McCauley, Martha H. Roper, Inger Damon, David L. Swerdlow."February 3, 2006."Cover title.The material in this report originated in the National Immunization Program, Anne Schuchat, MD, Director."Vaccinia Case Definition Development Working Group .... Advisory Committee on Immunization Practices-Armed Forces Epidemiological Board Smallpox Vaccine Safety Working Group" - p. 16Also available via the World Wide Web.Includes bibliographical references (p. 14-15)

Bat Rabies in Massachusetts, USA, 1985–2009

To investigate rabies in Massachusetts, we analyzed bat rabies test results before and after introduction of raccoon variant rabies and after release of revised 1999 US Advisory Committee on Immunization Practices recommendations for rabies postexposure prophylaxis. Bat submissions were associated with level of rabies awareness and specific postexposure recommendations

Evaluation of reporting timeliness of public health surveillance systems for infectious diseases

BACKGROUND: Timeliness is a key performance measure of public health surveillance systems. Timeliness can vary by disease, intended use of the data, and public health system level. Studies were reviewed to describe methods used to evaluate timeliness and the reporting timeliness of National Notifiable Diseases Surveillance System (NNDSS) data was evaluated to determine if this system could support timely notification and state response to multistate outbreaks. METHODS: Published papers that quantitatively measured timeliness of infectious disease surveillance systems operating in the U.S. were reviewed. Median reporting timeliness lags were computed for selected nationally notifiable infectious diseases based on a state-assigned week number and various date types. The percentage of cases reported within the estimated incubation periods for each disease was also computed. RESULTS: Few studies have published quantitative measures of reporting timeliness; these studies do not evaluate timeliness in a standard manner. When timeliness of NNDSS data was evaluated, the median national reporting delay, based on date of disease onset, ranged from 12 days for meningococcal disease to 40 days for pertussis. Diseases with the longer incubation periods tended to have a higher percentage of cases reported within its incubation period. For acute hepatitis A virus infection, which had the longest incubation period of the diseases studied, more than 60% of cases were reported within one incubation period for each date type reported. For cryptosporidiosis, Escherichia coli O157:H7 infection, meningococcal disease, salmonellosis, and shigellosis, less than 40% of cases were reported within one incubation period for each reported date type. CONCLUSION: Published evaluations of infectious disease surveillance reporting timeliness are few in number and are not comparable. A more standardized approach for evaluating and describing surveillance system timeliness should be considered; a recommended methodology is presented. Our analysis of NNDSS reporting timeliness indicated that among the conditions evaluated (except for acute hepatitis A infection), the long reporting lag and the variability across states limits the usefulness of NNDSS data and aberration detection analysis of those data for identification of and timely response to multistate outbreaks. Further evaluation of the factors that contribute to NNDSS reporting timeliness is warranted

Recommended childhood immunization schedule - United States, 1995

The need for a single childhood immunization schedule prompted the unification of previous vaccine recommendations made by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP). In addition to presenting the newly recommended schedule for the administration of vaccines during childhood, this report addresses the previous differences between the AAP and ACIP childhood vaccination schedules and the rationale for changing previous recommendations.Introduction -- Rationale for change and current recommendations -- Simultaneous administration of multiple vaccines -- Conclusion -- References.June 16, 1995.The following CDC staff members prepared this report: Jacqueline S. Gindler, Stephen C. Hadler, Peter M. Strebel, John C. Watson, Epidemiology and Surveillance Division, National Immunization Program,Includes bibliographical references p. 8-9

Strategic plan 2011-2015

"The National Center on Birth Defects and Developmental Disabilities (NCBDDD) works to advance the health and well-being of our nation's most vulnerable populations. Our focus on women, children, people with a range of disabilities and complex disabling conditions positions us as a resource within public health that is unique and vital. As we approach our ten year anniversary, a reflection on what we have accomplished and what we plan to achieve over the next five years is necessary. This plan describes our vision for the upcoming years and our commitment to achieve important health outcomes during that period." - p. 1"February 2011.""Established by the Children's Health Act of 2000, CDC's National Center on Birth Defects and Developmental Disabilities (NCBDDD) is currently organized into three divisions: Birth Defects and Developmental Disabilities (DBDDD), Blood Disorders (DBD), and Human Development and Disability (DHDD). Congress mandated the creation of the Center in response to strong advocacy efforts by external organizations whose view was that children's health issues were not being adequately addressed by CDC. Prior to formation of NCBDDD, CDC conducted an extensive internal assessment. This assessment focused on existing maternal-child health programs and it made recommendations about critical functions, programs and structure. The initial structure selected was the least disruptive to the Agency while also fulfilling the congressional mandate. It included the activities of two of the current divisions: Human Development and Disability and Birth Defects and Developmental Disabilities. It was not until 2004 that the Division of Blood Disorders was transferred to the Center from the National Center for Infectious Diseases. The rationale for moving Blood Disorders to NCBDDD was based upon the fact that the Center was already working on a number of chronic disability conditions with a strong genetic component." - p. 2Mode of access: Internet as an Acrobat .pdf file (1.25 MB, 52 p.)

Fetal alcohol syndrome: guidelines for referral and diagnosis

National Center on Birth Defects and Developmental Disabilities in coordination with National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect (American Academy of Pediatrics, American College of Obstetricians and Gynecologists, March of Dimes National Organization on Fetal Alcohol Syndrome)."July 2004, (2nd printing, August 2004), (3rd printing, May 2005)."Includes bibliographical references (p. 39-48)