Newborn screening for cystic fibrosis: a paradigm for public health genetics policy development : proceedings of a 1997 workshop

Cystic fibrosis (CF) is a genetic disease that can be detected in newborn infants (i.e., those aged < or = 1 month) by immunotrypsinogen testing. The sensitivity and specificity of such testing can now be improved as a result of the recent discovery of the Cystic Fibrosis Transmembrane Conductance Regulatory (CFTR) gene. Although limited CF screening for newborns has been used since the 1980s, the clinical, social, and economic outcomes of population-based screening are controversial. During January 1997, a workshop was convened at CDC in Atlanta, Georgia to discuss the benefits and risks associated with screening newborns for CF and to develop public health policy concerning such screening. The workshop planning committee comprised representatives from CDC, the Cystic Fibrosis Foundation, the National Institutes of Health, and the University of Wisconsin. Experts in the fields of CF, public health, the screening of newborns, and economics also contributed to discussions. Workshop participants addressed a) benefits and risks, b) laboratory testing, and c) economics concerning the implementation of routine CF screening for newborns. Summaries of these discussions and the resulting workshop recommendations are presented in this report. These recommendations, developed by workshop participants, will be useful to medical and public health professionals and state policymakers who are evaluating the merits of population-based screening of newborns for CF.Introduction -- Background -- Workshop objectives and agenda -- Summary of plenary presentations -- Work group summaries and recommendations -- Overall workshop conclusions and recommendations -- Reference.December 12, 1997.The material in this report was prepared for publication by: National Center for Environmental Health.The following CDC staff members prepared this report: Joanne Cono, Division of Birth Defects and Developmental Disabilities; Noreen L. Qualls, Division of Environmental Hazards and Health Effects; Muin J. Khoury, Office of Genetics and Disease Prevention; W. Harry Hannon, Division of Environmental Health Laboratory Sciences, National Center for Environmental Health; in collaboration with Philip M. Farrell, School of Medicine, University of WisconsinIncludes bibliographical references (22-24)

Protecting public health during drought conditions

"In April 2008, CDC, the American Water Works Association (AWWA), the National Oceanic and Atmospheric Administration (NOAA), and the U.S. Environmental Protection Agency (EPA) committed to collaboratively creating a guide for public health and other professionals concerned with the health implications of drought. Several key processes were employed over a period of months to help inform the writing of the drought document. CDC first conducted a review of the existing drought-related public health guidance, information, and literature, and identified a need for a consolidated drought planning resource for public health. A working group was then organized composed of both internal subject-matter experts and external experts representing diverse fields, including all levels of public health, environmental protection, and water-related sciences. Over the course of several months, the working group held a series of conference calls to discuss and prioritize the type of information that should be included in the proposed drought document, along with the appropriate format and structure. The research and consultations culminated in a 3-day workshop, which took place on September 17-19, 2008, in Atlanta, Georgia. The Public Health Effects of Drought Workshop was attended by experts from diverse disciplines, including federal, state, and local public health; environmental engineering and science; coastal ecology; regulatory engineering; water-related research; risk communication; water systems management; and emergency management (see Acknowledgments section for a list of participants and their affiliations). Participants were presented with several tasks during the 3-day meeting. They worked together through a computer-based communications/facilitation tool and engaged in discussions to identify and prioritize drought-related public health issues, identify research gaps and needs in the area of public health as it relates to drought, and develop recommendations to ensure that the nation's public health system is better prepared for drought. Workshop participants also shared personal experiences with drought within their regions, including lessons learned, best practices, and challenges. The recommendations contained within this document are based on the experience and knowledge of the working group members who participated in numerous conference calls, the experts who attended the 2008 Public Health Effects of Drought Workshop, and the literature and data that have been collected regarding the impact of drought on health. The document has been reviewed and vetted by CDC, AWWA, EPA, NOAA, and other stakeholder agencies and organizations, including the Association of State and Territorial Health Officials (ASTHO), the National Association of Local Boards of Health (NALBOH), and the National Association of County and City Health Officials (NACCHO)." - p. 13Acknowledgments -- Executive summary -- Introduction -- Background -- Drought basics. -- Water basics -- Water-related policy -- The impact of drought on health. -- Preparing for and responding to drought -- Response: public health activities for late-stage severe drought conditions -- Future needs: drought-related research and initiatives. -- Drought resources for public health professionals -- References -- Additional resources -- Appendix. Target audiences, communication objectives, and communication actions"CS214614-A."The Centers for Disease Control and Prevention's (CDC) National Center for Environmental Health (NCEH) would like to thank all agencies, organizations, and individuals who either assisted directly in or supported the development of When Every Drop Counts: Protecting Public Health During Drought Conditions--A Guide for Public Health Professionals. In addition to CDC/NCEH, other primary agencies and organizations who coordinated the development of this guide are the American Water Works Association (AWWA), the U.S. Environmental Protection Agency (EPA), and the National Oceanic and Atmospheric Administration (NOAA). Special thanks are offered to members who participated in the Public Health Effects of Drought Workshop (facilitated by Brett Boston and Vern Herr of Group Solutions, Inc.) held in Atlanta in September 2008. Their expertise, input, and insight greatly contributed to the development of this guide. Other individuals offered recommendations, consultation, and advice through conference calls, in-person meetings, and document reviews.This guide reflects the commitment of many individuals who contributed their time, skills, and expertise to its development. Members of the CDC/NCEH project coordinating group include Rob Blake, Val Carlson, Katelyn Hardy, Martin Kalis, and CAPT Mark Miller.Ultimately, however, this guide could not have been developed without the expertise and patience of our technical writer/editor, Rachel Wilson. Ms. Wilson worked closely with the CDC/NCEH project coordination group to develop a draft version of the guide, prepare it for external review, and incorporate suggestions and revisions offered by key partners and stakeholders.Also avavailable via the World Wide Web as an Acrobat .pdf file (5MB, 56 p.).Includes bibliographical references (p. 42-44).Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, National Oceanic and Atmospheric Agency, and American Water Works Association. 2010. When every drop counts: protecting public health during drought conditions--a guide for public health professionals. Atlanta: U.S. Department of Health and Human Services

Environmental public health tracking program: closing America's environmental public health gap, 2003

"Environmental public health tracking is the ongoing collection, integration, analysis, and interpretation of data about environmental hazards, exposure to environ mental hazards, and human health effects potentially related to exposure to environmental hazards. It includes dissemination of information learned from these data. The mission of environmental public health tracking_is to improve the health of communities. Using infor- mation from an environmental public health tracking network, federal, state, and local agencies will be better prepared to develop and evaluate effective public health actions to prevent or control chronic and acute diseases that can be linked to hazards in the environment. Health- care providers can provide better care and targeted preventive services. In addition, the public will have a better understanding of what is occurring in their communities and what actions they may take to protect or improve their health. CDC's goal is to develop a national network that will (1) be standards-based; (2) allow direct electronic data reporting and linkage within and across health effect, exposure, and hazard data; and (3) interoperate with other public health systems." - p. 1Caption title."March 2003"--p. 4."NCEH Pub No. 03-0051"--p. 4

Using tandem mass spectrometry for metabolic disease screening among newborns: a report of a Work Group

Increasingly, tandem mass spectrometry (MS/MS) is being used for newborn screening because this laboratory testing technology substantially increases the number of metabolic disorders that can be detected from dried blood-spot specimens. In June 2000, the National Newborn Screening and Genetics Resource Center, in collaboration with CDC and the Health Resources and Services Administration, convened a workshop in San Antonio, Texas. Workshop participants examined programmatic concerns for health providers choosing to integrate MS/MS technology into their newborn screening activities. Representatives from approximately 50 public and private health agencies and universities participated in the workshop. The workshop participants and work group focused on laboratory methodology, decision criteria, quality assurance, diagnostic protocols, patient case management, and program evaluation for using MS/MS to analyze dried blood spots routinely collected from newborns. This work group report contains proposals for planning, operating, and evaluating MS/MS technology in newborn screening and maternal and child health programs. As a supplement to these proposals, this report contains synopses of selected presentations made at the 2000 workshop regarding integration of MS/MS technology into newborn screening programs. The proposals contained in this report should assist policymakers, program managers, and laboratorians in making informed decisions regarding the process of including MS/MS technology in their newborn screening and maternal and child health programs.Introduction -- Background -- Laboratory practice -- Newborn screening follow-up -- Diagnosis and treatment -- MS/MS screening evaluation -- Conclusion -- References -- Appendix: Synopses of selected papers presented at the tandem Mass Spectometry for Metabolic Disease Screening Among Newborns Workshop, San Antonio, Texas, June 2000.April 13, 2001.The following CDC staff members prepared this report: W. Harry Hannon, Scott D. Grosse, National Center for Environmental Health.Includes bibliographical references (p. 21-22)

A Survey of the quality of water drawn from domestic wells in nine Midwest states

"Domestic wells, cisterns, or springs supply drinking water to eighteen percent of the households in the nine upper midwestern states. Many of these wells were in areas of the Missouri and Mississippi River basins that were flooded during the 1993 midwest flood. After the flood waters receded, many state and county sanitarians reported that water samples collected from domestic wells in the flooded river basins contained coliform bacteria. Since the nature and magnitude of this contamination was unknown, a survey was initiated to assess the presence of bacteria and chemicals in water drawn from domestic wells in the states that were severely affected by the flood. The survey was conducted in May to November of 1994 by state health and environmental departments of nine midwestern states with assistance from the Centers for Disease Control and Prevention (CDC). Because samples were collected one year after flooding and few of the sampled wells had preflood water quality results, the effect of this disturbance on the water quality of domestic wells could not be evaluated. Water samples were collected from 5520 households with domestic wells. These houses were near the intersections of a 10 mile grid overlaid on a map of Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, and Wisconsin. Samples were usually collected from the household faucet that was used to supply drinking water. Coliform bacteria, Escherichia coli, nitrate, and atrazine were measured. The coliform bacteria and E. coli serve as indicators of contamination and their presence in water supply systems indicate an increased risk for diarrheal illnesses. Fertilizers and herbicides are intensely applied in rural areas of the Midwest, the location of most domestic wells. "[Centers for Disease Control and Prevention, National Center for Environmental Health]."NCEH 97-0265."The 1994 Midwest Well Water Survey was funded by United States Public Health Service Office of Emergency Preparedness through the 1993 Midwest Flood Supplemental Appropriations

Environmental public health at CDC

CDC's environmental public health work cuts across several centers. The National Center for Environmental Health (NCEH) focuses on the following program areas: Safeguarding the health of people from environmental threats; Providing leadership in the use of environmental health sciences-including environmental epidemiology, environmental sanitation, and laboratory sciences-to protect public health; Responding and sharing solutions to environmental public health problems worldwide. NCEH consists of: The Division of Laboratory Sciences, which develops and applies laboratory science to: Prevent disease and death caused by exposure to toxic substances that result from chemical emergencies or chemical terrorism; Assist disease-prevention programs requiring special laboratory expertise; the Division of Emergency and Environmental Health Services, which provides national and international leadership for coordinating, delivering, and evaluating emergency and environmental public health services; the Division of Environmental Hazards and Health Effects, which investigates the relation between human health and the environment. This brochure provides an "A-to-Z" overview of the many environmental public health programs and activities in which we are engaged. Each of our programs and activities not only advances the mission of NCEH: to promote health and quality of life by preventing or controlling those diseases or deaths that result from interactions between people and their environment--but also the overall mission of CDC--to promote health and quality of life by preventing and controlling disease, injury, and disability."NCEH 03-0275."Title from title screen (viewed on August 11, 2010).Available on the internet as an Acrobat .pdf file (425 KB, 8 p.).Mode of access: Internet.System requirements: Adobe Acrobat Reader

Lead in drinking water and human blood lead levels in the United States

"Lead is a pervasive environmental contaminant. The adverse health effects of lead exposure in children and adults are well documented, and no safe blood lead threshold in children has been identified. Lead can be ingested from various sources, including lead paint and house dust contaminated by lead paint, as well as soil, drinking water, and food. The concentration of lead, total amount of lead consumed, and duration of lead exposure influence the severity of health effects. Because lead accumulates in the body, all sources of lead should be controlled or eliminated to prevent childhood lead poisoning. Beginning in the 1970s, lead concentrations in air, tap water, food, dust, and soil began to be substantially reduced, resulting in significantly reduced blood lead levels (BLLs) in children throughout the United States. However, children are still being exposed to lead, and many of these children live in housing built before the 1978 ban on lead-based residential paint. These homes might contain lead paint hazards, as well as drinking water service lines made from lead, lead solder, or plumbing materials that contain lead. Adequate corrosion control reduces the leaching of lead plumbing components or solder into drinking water. The majority of public water utilities are in compliance with the Safe Drinking Water Act Lead and Copper Rule (LCR) of 1991. However, some children are still exposed to lead in drinking water. EPA is reviewing LCR, and additional changes to the rule are expected that will further protect public health. Childhood lead poisoning prevention programs should be made aware of the results of local public water system lead monitoring measurement under LCR and consider drinking water as a potential cause of increased BLLs, especially when other sources of lead exposure are not identified. This review describes a selection of peer-reviewed publications on childhood lead poisoning, sources of lead exposure for adults and children, particularly children aged <6 years, and LCR. What is known and unknown about tap water as a source of lead exposure is summarized, and ways that children might be exposed to lead in drinking water are identified. This report does not provide a comprehensive review of the current scientific literature but builds on other comprehensive reviews, including the Toxicological Profile for Lead and the 2005 CDC statement Preventing Lead Poisoning Among Young Children. When investigating cases of children with BLLs at or above the reference value established as the 97.5 percentile of the distribution of BLLs in U.S. children aged 1-5 years, drinking water should be considered as a source. The recent recommendations from the CDC Advisory Committee on Childhood Lead Poisoning Prevention to reduce or eliminate lead sources for children before they are exposed underscore the need to reduce lead concentrations in drinking water as much as possible.." -p. 1Introduction -- Background -- Historical trends in blood lead levels -- Lead in the environments of children -- Lead in drinking water -- Conclusion -- ReferencesMary Jean Brown, Stephen Margolis, Division of Emergency and Environmental Health Services, National Center for Environmental Health."August 10, 2012.."Also available via the World Wide Web as an Acrobat .pdf file (349.49 KB, 12 p.).Includes bibliographical references (p. 7-9)

NNIP

"In January 2001, the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the U.S. Congress appropriated funding to the Centers for Disease Control and Prevention (CDC) in Fiscal Year (FY) 2002. This funding enabled CDC to develop the National Environmental Public Health Tracking Program (referred to as Tracking Program). The purpose of the CDC's Tracking Program is to establish a nationwide tracking network to obtain integrated health and environmental data and use it to provide information in support of actions that improve the health of communities. CDC is establishing the Tracking Network by drawing from a wide range of stakeholders with expertise from federal, state, and local health and environmental agencies; nongovernmental organizations (NGOs); state public health and environmental laboratories; and schools of public health. The difference between the Tracking Program and the Tracking Network is that the Tracking Program is much broader and includes not only the Tracking Network but the people, resources, and program management involved in building this network. The Tracking Network is a discrete product of the Tracking Program. The Tracking Program can use data gathered from the Tracking Network to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. Analyses of data from the Tracking Network will provide valuable information on changes or trends in levels of pollutants, population exposure, and occurrence of noninfectious health effects and enable environmental public health practitioners and researchers to examine the possible relations among them. The information can be used to drive public health policy and actions that ultimately will reduce the burden of adverse health effects on the American public. This document, CDC's National Environmental Public Health Tracking Program: National Network Implementation Plan (NNIP), outlines the path that the Tracking Program is taking to develop and implement the Tracking Network over the next 5 years. The plan supports achieving success in both immediate and long-term time frames while providing direction and guidance to the many stakeholders who contribute to the Tracking Network's ongoing development as well as the overall program's implementation. The NNIP gives insight into the topics and approaches that lead to improved network performance, sustainability, quality, and focus. The NNIP outlines CDC's strategy for developing and implementing the Tracking Network by clarifying functions and components and describing approaches to developing the components. Specifically, the NNIP describes the background, context, needs, and goals of the Tracking Network; outlines the principal functions and components of the Tracking Network; discusses the steps needed to implement the components; and identifies the entities responsible for taking the implementation steps." - p. iiiExecutive summary -- 1. Introduction -- 2. What are the functions and uses of the tracking network? -- 3. What are the components of the tracking network? -- 4. How is the tracking network accessed? -- 5. What services does the tracking network provide? -- 6. What content is on the tracking network? -- 7. Implementation activities -- Appendix A: Summary of activities by responsible entities for tracking network development -- Appendix B: Overview of NNIP development -- Appendix C: Acronyms and abbreviationsTitle from PDF title screen (CDC, viewed Dec. 29, 2011)."August 2006.""C5116250."Available via the World Wide Web as an Acrobat .pdf file (PDF 1.27 MB, 71 p.)

A Guide to conducting household surveys for water safety plans

Water Safety Plans are a World Health Organization (WHO) methodology designed to assess and manage risk in drinking water systems. A Water Safety Plan (WSP) aims to identify hazards to drinking water quality that can be introduced at multiple points from the source to the tap. The WSP does not, however, traditionally provide for identifying hazards that could compromise drinking water quality after it reaches the household tap, such as contamination associated with water collection, storage, and treatment practices within the home. A household survey can help researchers to understand the fate of water from the time it reaches the home to the point of consumption. It can provide valuable information about the quality and reliability of water reaching the home and changes to water quality through household storage and treatment. It can also provide information on the prevalence of water-related illnesses, community perceptions and concerns, alternate or supplemental water sources, and customer satisfaction, information that may fall outside the purview of a traditional Water Safety Plan. A household survey contributes to Module 2 (System Assessment) of the Water Safety Plan, upon which the subsequent steps of hazard identification, consideration of control measures, and development of corrective actions, monitoring, and verification plans are based. Thus, the survey provides valuable information for the WSP team as the team goes through the process of system evaluation and implementation of changes resulting from the Water Safety Plan. The aim of this manual is to provide guidance on conducting a household survey as part of a Water Safety Plan for organized piped water supply systems in resource-limited settings. Specific examples intended to guide the planner in designing the survey are provided in the appendices.Introduction -- Before you start -- Time lines -- Budget planning -- Informed consent/human subjects protection -- Determining sample size -- Survey design -- Household selection -- Recruitment and training of the survey team -- Developing the survey questionnaire -- water quality testing of household sources -- Data entry, analysis and reporting -- Alternatives to a household survey -- Appendix A. Section-by-section summary survey planning checklist -- Appendix B. Sample budget estimate for WSP Household Survey -- Appendix C. Sample informed consent for WSP Household Survey -- Appendix D. Method for calculating sample size for a WSP Household Survey -- Appendix E. Sample household (HH) tracking log -- Appendix F. Sample daily household visitation log sheet -- Appendix G. Sample contracts for survey personnel -- Appendix H. Sample WSP Household Survey training program -- Appendix I. Survey instrument for a WSP Household Survey.U.S. Centers for Disease Control and Prevention (CDC).Available via the World Wide Web as an Acrobat .pdf file (379.12 KB, 52 p.).Centers for Disease Control and Prevention. 2008. A guide to conducting household surveys for Water Safety Plans. Atlanta: U. S. Department of Health and Human Services

Acute idiopathic pulmonary hemorrhage among infants: recommendations from the Working Group for Investigation and Surveillance

This report presents CDC's recommended case definitions and surveillance practices for Acute Idiopathic Pulmonary Hemorrhage (AIPH). In 1994 and 1997, CDC reported clusters of acute pulmonary hemorrhage (APH) among infants in Cleveland, Ohio. Subsequent reviews of these investigations identified shortcomings in the conduct of the studies and concluded that the investigations did not prove an association between APH among infants and exposure to molds. In response to recommendations from these reviews, with assistance of external consultants, CDC staff developed a plan to conduct surveillance for and investigation of AIPH. In developing this response, CDC recommends a definition for a clinically confirmed case of AIPH among infants on the basis of evidence of blood in the airway, age </=1 year, absence of medical conditions related to pulmonary hemorrhage, and severe acute respiratory distress or respiratory failure. CDC recommends that pediatric intensive care units (PICUs) report cases that meet the CDC case definition to state health departments. CDC staff will study the number of reported cases of AIPH among infants and also review the Cleveland and Chicago case series to determine the degree to which the present case definition applies to them. If these reviews establish that AIPH among infants is a public health problem, on the basis of its magnitude or geographic or temporal distribution, targeted case surveillance will be initiated based on the distribution of cases. CDC staff will work with state and local health departments to investigate reported clusters of cases of AIPH among infantsBackground -- Case definition -- Feasibility study to determine the concordance of ICD codes for pulmonary hemorrhage with the CDC case definition -- Conclusion -- Acknowledgments -- Referencesprepared by Clive M. Brown, Stephen C. Redd, Scott A. Damon, Division of Environmental Hazards and Health Effects, National Center for Environmental Health.The material in this report originated in the National Center for Environmental Health and the Division of Environmental Hazards and Health Effects.Bibliography: p. 12.15017372Environmental HealthSurveillance and InvestigationCurren