Guidelines for assuring the accuracy and reliability of HIV rapid testing: applying a quality system approach

NPIN 33841: "This monograph provides guidelines for applying a quality system approach to HIV rapid testing. The quality system is divided into twelve essential elements: Organization and Management, Personnel, Equipment, Purchasing and Inventory, Process Control, Documents and Records, Information Management, Occurrence Management, Assessment, Process Improvement, Service and Satisfaction, Facilities and Safety. The monograph outlines the responsibilities at the national level for establishing a laboratory quality system, the planning that is required, and the responsibilities at the laboratory or facility level. It discusses the importance of the initial and ongoing training and evaluation of personnel; evaluation methods; standard operating procedure; and quality control procedures. The appendices present a CDC/WHO training program for rapid testing, examples of a stock card and stock book to use for inventory control, an example of a standard operating procedure, a quality control form, a protocol for preparing HIV-positive quality control materials, external quality assessment of HIV rapid tests and on-site monitoring including an onsite monitoring checklist, and examples of documents and records useful in a rapid testing site."Also available via the World Wide Web as and Acrobat .pdf file (1.1 MB, 71 p.).Jointly published by the World Health Organization, Centers for Disease Control and Prevention (U. S.), Office of the United States Global AIDS Coordinator, and the U. S. Dept. of Health and Human Services

CDC HIV prevention strategic plan: extended through 2010

"This plan extends the HIV Prevention Strategic Plan Through 2005 (2001 Plan) published by the Centers for Disease Control and Prevention (CDC) in January 2001. The short-term goal, milestones, and accompanying objectives are based on general and specific recommendations from the CDC and HRSA Advisory Committee on HIV and STD Prevention and Treatment (CHAC), formerly known as the Advisory Committee for HIV and STD Prevention. The HIV Prevention Strategic Plan: Extended Through 2010 ( Extended Plan), which will serve as CDC's strategic guide for HIV prevention through 2010, includes a short-term goal of reducing new HIV infections by 5 percent per year or at least 10 percent by the end of 2010. To achieve this goal, the Extended Plan includes an expanded set of objectives and performance indicators that make priorities more explicit and ensure that key issues are effectively addressed. Twelve new objectives have been added, 20 existing objectives have been modified, and one objective was deleted (42 objectives total, compared to 27 in the 2001 Plan). The Extended Plan also incorporates 17 additional performance indicators (25 total, compared to 11 previously)." p. 2-3Introduction -- Background of the CDC HIV Prevention Strategic Plan, 2001-2005 -- CDC Activities to Implement the 2001-2005 HIV Prevention Strategic Plan -- CHAC Strategic Plan Workgroup -- CDC Response to CHAC Recommendations and Major Considerations of the Plan -- Looking Ahead: The Future of HIV Prevention Strategic Planning at CDC -- Goals and Objectives of the CDC HIV Prevention Strategic Plan: Extended Through 2010 -- HIV Prevention Strategic Plan Performance Indicators -- Appendix 1 : November 2006 CHAC Meeting Minutes -- Appendix 2 : List of CHAC Strategic Plan Workgroup Members -- Appendix 3 - CDC Summary Report of Activities Addressing Plan (submitted to CHAC) -- Appendix 4 : Draft Report from CHAC Strategic Plan WorkgroupTitle from cover."October 2007"Also available via the World Wide Web

Tetanus surveillance : United States, 1991-1994

Surveillance for chronic fatigue syndrome : four U.S. cities, September 1989 through August 1993: PROBLEM/CONDITION: Although chronic fatigue syndrome (CFS) has been recognized as a cause of morbidity in the United States, the etiology of CFS is unknown. In addition, information is incomplete concerning the clinical spectrum and prevalence of CFS in the United States. REPORTING PERIOD COVERED: This report summarizes CFS surveillance data collected in four U.S. cities from September 1989 through August 1993. DESCRIPTION OF SYSTEM: A physician-based surveillance system for CFS was established in four U.S. metropolitan areas: Atlanta, Georgia; Wichita, Kansas; Grand Rapids, Michigan; and Reno, Nevada. The objectives of this surveillance system were to collect descriptive epidemiologic information from patients who had unexplained chronic fatigue, estimate the prevalence and incidence of CFS in defined populations, and describe the clinical course of CFS. Patients aged > or = 18 years who had had unexplained, debilitating fatigue or chronic unwellness for at least 6 months were referred by their physicians to a designated health professional(s) in their area. Those patients who participated in the surveillance system a) were interviewed by the health professional(s); b) completed a self-administered questionnaire that included their demographic information, medical history, and responses to the Beck Depression Inventory, the Diagnostic Interview Schedule, and the Sickness Impact Profile; c) submitted blood and urine samples for laboratory testing; and d) agreed to a review of their medical records. On the basis of this information, patients were assigned to one of four groups: those whose illnesses met the criteria of the 1988 CFS case definition (Group I); those whose fatigue or symptoms did not meet the criteria for CFS (Group II); those who had had an identifiable psychological disorder before onset of fatigue (Group III); and those who had evidence of other medical conditions that could have caused fatigue (Group IV). Patients assigned to Group III were further evaluated to determine the group to which they would have been assigned had psychological illness not been present, the epidemiologic characteristics of the illness and the frequency of symptoms among patients were evaluated, and the prevalence and incidence of CFS were estimated for each of the areas. RESULTS: Of the 648 patients referred to the CFS surveillance system, 565 (87%) agreed to participate. Of these, 130 (23%) were assigned to Group I; 99 (18%), Group II; 235 (42%), Group III; and 101 (18%), Group IV. Of the 130 CFS patients, 125 (96%) were white and 111 (85%) were women. The mean age of CFS patients at the onset of illness was 30 years, and the mean duration of illness at the time of the interview was 6.7 years. Most (96%) CFS patients had completed high school, and 38% had graduated from college. The median annual household income/for CFS patients was $40,000. In the four cities, the age-, sex-, and race-adjusted prevalences of CFS for the 4-year surveillance period ranged from 4.0 to 8.7 per 100,000 population. The age-adjusted 4-year prevalences of CFS among white women ranged from 8.8 to 19.5 per 100,000 population. INTERPRETATION: The results of this surveillance system were similar to those in previously published reports of CFS. Additional studies should be directed toward determining whether the data collected in this surveillance system were subject to selection bias (e.g., education and income levels might have influenced usage of the health-care system, and the populations of these four surveillance sites might not be representative of the U.S. population). ACTIONS TAKEN: In February 1997, CDC began a large-scale, cross-sectional study at one surveillance site (Wichita) to describe more completely the magnitude and epidemiology of unexplained chronic fatigue and CFS.Malaria surveillance : United States, 1993: PROBLEM/CONDITION: Malaria is caused by infection with one of four species of Plasmodium (P. falciparum, P. vivax, P. ovale, and P. malariae), which are transmitted by the bite of an infective female Anopheles sp. mosquito. Most malaria cases in the United States occur among persons who have traveled to areas (i.e., other countries) in which disease transmission is ongoing. However, cases are transmitted occasionally through exposure to infected blood products, by congenital transmission, or by local mosquito-borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations. REPORTING PERIOD COVERED: Cases with onset of illness during 1993. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are reported to local and/or state health departments by health-care providers and/or laboratories. Case investigations are conducted by local and/or state health departments, and the reports are transmitted to CDC. RESULTS: CDC received reports of 1,275 cases of malaria in persons in the United States and its territories who had onset of symptoms during 1993; this number represented a 40% increase over the 910 malaria cases reported for 1992. P. vivax, P. falciparum, P. ovale, and P. malariae were identified in 52%, 36%, 4%, and 3% of cases, respectively. The species was not determined in the remaining 5% of cases. The 278 malaria cases in U.S. military personnel represented the largest number of such cases since 1972; 234 of these cases were diagnosed in persons returning from deployment in Somalia during Operation Restore Hope. In New York City, the number of reported cases increased from one in 1992 to 130 in 1993. The number of malaria cases acquired in Africa by U.S. civilians increased by 45% from 1992; of these, 34% had been acquired in Nigeria. The 45% increase primarily reflected cases reported by New York City. Of U.S. civilians who acquired malaria during travel, 75% had not used a chemoprophylactic regimen recommended by CDC for the area in which they had traveled. Eleven cases of malaria had been acquired in the United States: of these cases, five were congenital; three were induced; and three were cryptic, including two cases that were probably locally acquired mosquito-borne infections. Eight deaths were associated with malarial infection. INTERPRETATION: The increase in the reported number of malaria cases was attributed to a) the number of infections acquired during military deployment in Somalia and b) complete reporting for the first time of cases from New York City. ACTIONS TAKEN: Investigations were conducted to collect detailed information concerning the eight fatal cases and the 11 cases acquired in the United States. Malaria prevention guidelines were updated and disseminated to health-care providers. Persons who have a fever or influenza-like illness after returning from a malarious area should seek medical care, regardless of whether they took antimalarial chemoprophylaxis during their stay. The medical evaluation should include a blood smear examination for malaria. Malaria can be fatal if not diagnosed and treated rapidly. Recommendations concerning prevention and treatment of malaria can be obtained from CDC.Tetanus surveillance : United States, 1991-1994: PROBLEM/CONDITION: Despite the widespread availability of a safe and effective vaccine against tetanus, 201 cases of the disease were reported during 1991-1994. Of patients with known illness outcome, the case-fatality rate was 25%. REPORTING PERIOD COVERED: 1991-1994. DESCRIPTION OF SYSTEM: Physician-diagnosed cases of tetanus are reported to local and state health departments, the latter of which reports these cases on a weekly basis to CDC's National Notifiable Disease Surveillance System. Since 1965, state health departments also have submitted supplemental clinical and epidemiologic information to CDC's National Immunization Program. RESULTS: During 1991-1994, 201 cases of tetanus were reported from 40 states, for an average annual incidence of 0.02 cases per 100,000 population. Of the 188 patients for whom age was known, 101 (54%) were aged > or = 60 years and 10 (5%) were aged or = 80 years was more than 10 times greater than the risk for persons aged 20-29 years. All deaths occurred among persons aged > or = 30 years. The case-fatality rate (overall: 25%) increased with age, from 11% in persons aged 30-49 years to 54% in persons aged > or = 80 years. Only 12% of all patients were reported to have received a primary series of tetanus toxoid before onset of illness. For 77% of patients, tetanus occurred after an acute injury was sustained. Of patients who obtained medical care for their injury, only 43% received tetanus toxoid as part of wound prophylaxis. INTERPRETATION: The epidemiology of reported tetanus in the United States during 1991-1994 was similar to that during the 1980s. Tetanus continued to be a severe disease primarily of older adults who were unvaccinated or inadequately vaccinated. Most tetanus cases occurred after an acute injury was sustained, emphasizing the need for appropriate wound management. ACTIONS TAKEN: In addition to decennial booster doses of tetanus-diphtheria toxoid during adult life, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination visits for adolescents at age 11-12 years and for adults at age 50 years to enable health-care providers to review vaccination histories and administer any needed vaccine. Full implementation of the ACIP recommendations should virtually eliminate the remaining tetanus burden in the United States.Surveillance for chronic fatigue syndrome : four U.S. cities, September 1989 through August 1993 / Michele Reyes, Howard E. Gary, Jr., James G. Dobbins, Bonnie Randall, Lea Steele, Keiji Fukuda, MGary P. Holmes, David G. Connell, Alison C. Mawle, D. Scott Schmid, John A. Stewart, Lawrence B. Schonberger, Walter J. Gunn, William C. Reeves -- Tetanus surveillance : United States, 1991-1994 / Hector S. Izurieta, Roland W. Sutter, Peter M. Strebel, Barbara Bardenheier, D. Rebecca Prevots, Melinda Wharton, Stephen C. Hadler, Epidemiology and Surveillance Division. National Immunization Program; Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases -- Malaria surveillance : United States, 1993 / Lawrence M. Barat, Jane R. Zucker, Ann M. Barbe,r Monica E. Parise, Lynn A. Paxton, Jacqueline M. Roberts, Carlos C. Campbell, Division of Parasitic Diseases National Center for Infectious Diseases.February 21, 1997Includes bibliographical references

Guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: November 28, 2001

NPIN 22737: This guideline lists each opportunistic infection and provides information on primary and secondary infection, prevention of exposure, and treatment recommendations as well as criteria for discontinuation of treatment. It covers Pneumocystic Pneumonia, Toxoplasmic Encephalitis, Cryptosporidiosis, Microsporidiosis, Tuberculosis, Disseminated Infection with Mycobacterium avium Complex, Bacterial Respiratory Infections, Bacterial Enteric Infections, Bartonellosis, Candidiasis, Cryptococcosis, Histoplasmosis, Coccidioidomycosis, Cytomegalovirus Disease, Herpes Simplex Disease, Varicella Zoster Virus Disease, Human Herpesvirus 8 Infection, Human Papillomavirus Infection, and Hepatitis C Virus Infection including special considerations for children and pregnant women. The appendix provides recommendations to help patients avoid exposure to, or infection with, opportunistic pathogens through sexual, injection drug use, environmental and occupational, pet-related, food and water-related, and travel-related exposures.Cover title.Issued also online.Includes bibliographical references (p. 31-37)

Laboratory-based surveillance for meningococcal disease in selected areas--United States, 1989-1991

Surveillance for diabetes mellitus--United States, 1980-1989: "Problem/Condition: In the United States, diabetes mellitus is the most important cause of lower-extremity amputation and end-stage renal disease; the major cause of blindness among working-age adults; a major cause of disability, premature mortality, congenital malformations, perinatal mortality, and health-care costs; and an important risk factor for the development of many other acute and chronic conditions (e.g., diabetic ketoacidosis, ischemic heart disease, stroke). Surveillance data describing diabetes and its complications are critical to increasing recognition of the public health burden of diabetes, formulating health-care policy, identifying high-risk groups, developing strategies to reduce the burden of this disease, and evaluating progress in disease prevention and control. Reporting Period Covered: In this report, data are summarized from CDC's diabetes surveillance system; trends in diabetes and its complications are evaluated by age, sex, and race for the years 1980-1989. Description of System: CDC has established an ongoing and evolving surveillance system to analyze and compile periodic, representative data on the disease burden of diabetes and its complications in the United States. Data sources currently include vital statistics, the National Health Interview Survey, the National Hospital Discharge Survey, and Medicare claims data for end-stage renal disease. Results and Interpretation: In 1989, approximately 6.7 million persons in the United States reported that they had diabetes mellitus, and a similar number probably had this disabling chronic disease without being aware of it. The disease burden of diabetes and its complications is large and is likely to increase as the population grows older. Effective primary, secondary, and tertiary prevention strategies are needed, and these efforts need to be intensified among groups at highest risk, including blacks. Important gaps exist in periodic and representative data for describing the disease burden. Actions Taken: CDC is assisting diabetes control programs in 26 states and one territory. These programs attempt to reduce the burden of diabetes by preventing blindness, lower-extremity amputations, cardiovascular disease, and adverse outcomes of pregnancy among persons with diabetes. Because of important limitations in measuring the burden of diabetes, CDC is exploring sources of surveillance data for blindness, adverse outcomes of pregnancy, and the public health burden of diabetes among minority groups." - p. 1Laboratory-based surveillance for meningococcal disease in selected areas--United States, 1989-1991: "Problem/Condition: Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in the United States. Accurate surveillance for meningococcal disease is required to detect trends in patient characteristics, antibiotic resistance, and serogroup-specific incidence of disease. Reporting Period Covered: January 1989 through December 1991. Description of System: A case of meningococcal disease was defined by the isolation of N. meningitidis from a normally sterile site, such as blood or cerebrospinal fluid, in a resident of a surveillance area. Cases were reported by personnel in each hospital laboratory in the surveillance areas. The surveillance areas consisted of three counties in the San Francisco metropolitan area, eight counties in the Atlanta metropolitan area, four counties in Tennessee, and the entire state of Oklahoma. Results: Age- and race-adjusted projections of the U.S. population suggest that approximately 2,600 cases of meningococcal disease occurred annually in the United States. The case-fatality rate was 12%. Incidence declined from 1.3/100,000 in 1989 to 0.9/100,000 in 1991. Seasonal variation occurred, with the highest attack rates in February and March and the lowest in September. The highest rates of disease were among infants, with 46% of cases affecting those 2 years of age. Actions Taken: Current recommendations against the use of sulfa drugs for treatment or prophylaxis of meningococcal disease unless the organism is known to be sensitive to sulfa should be continued. Since resistance to rifampin is rarely reported, it continues to be the drug of choice for prophylaxis. The development of vaccines effective for infants and vaccines inducing protection against serogroup B would be expected to have a substantial impact on disease." - p. 21Surveillance for diabetes mellitus, United States, 1980-1989 / Linda S. Geiss, William H. Herman, Merilyn G. Goldschmid, Frank DeStefano, Mark S. Eberhardt, Earl S. Ford, Robert R. German, Jeffrey M. Newman, David R. Olson, Stephen J. Sepe, John M. Stevenson, Frank Vinicor, Scott F. Wetterhall, Julie C. Will -- Laboratory-based surveillance for meningococcal disease in selected areas, United States, 1989-1991 / Lisa A. Jackson, Jay D. Wenger, Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases and the Meningococcal Disease Study GroupIncludes bibliographical references (p. 19-20, p. 29-30)

Guidelines for school health programs to promote lifelong healthy eating

"Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems, such as iron deficiency anemia, obesity, eating disorders, and dental caries; and may prevent long-term health problems, such as coronary heart disease, cancer, and stroke. School health programs can help children and adolescents attain full educational potential and good health by providing them with the skills, social support, and environmental reinforcement they need to adopt long-term, healthy eating behaviors. This report summarizes strategies most likely to be effective in promoting healthy eating among school-age youths and provides nutrition education guidelines for a comprehensive school health program. These guidelines are based on a review of research, theory, and current practice, and they were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies. The guidelines include recommendations on seven aspects of a school-based program to promote healthy eating: school policy on nutrition, a sequential, coordinated curriculum, appropriate instruction for students, integration of school food service and nutrition education, staff training; family and community involvement, and program evaluation." - p. 1Cover title."June 14, 1996."Shelley Evans, Jeannie McKenzie, Barbara Shannon, Howell Wechsler assisted in the preparation of this report.Also available via the World Wide Web.Includes bibliographical references (p. 23-33)

Guidance about SARS for airline flight crews, cargo and cleaning personnel, and personnel interacting with arriving passengers

This guidance is intended to assist commercial passenger airlines and the Transportation Security Administration (TSA), Bureau of Customs and Border Protection (BCBP), and other relevant agencies in establishing appropriate SARS-related precautions. Recommendations are based on standard infection control practices and on available epidemiologic information about the virus that causes SARS. To supplement the general information provided here, the following sections provide information related to specific job functions: Guidance for Airline Flight Crews about Management of Passengers with Possible SARS; Guidance about SARS for Airline Cleaning Personnel; Guidance about SARS for Airline Cargo Personnel; Guidance about SARS for Personnel Who Interact with Passengers Arriving from Areas with SARS."April 23, 2004."Mode of access: Internet from the CDC web site as Acrobat .pdf file (122 KB, 7 p. )

School health guidelines to prevent unintentional injuries and violence

"Approximately two thirds of all deaths among children and adolescents aged 5-19 years result from injury-related causes: motor-vehicle crashes, all other unintentional injuries, homicide, and suicide. Schools have a responsibility to prevent injuries from occurring on school property and at school-sponsored events. In addition, schools can teach students the skills needed to promote safety and prevent unintentional injuries, violence, and suicide while at home, at work, at play, in the community, and throughout their lives. This report summarizes school health recommendations for preventing unintentional injury, violence, and suicide among young persons. These guidelines were developed by CDC in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in unintentional injury, violence, and suicide prevention; health education; and public health. Every recommendation is not appropriate or feasible for every school to implement. Schools should determine which recommendations have the highest priority based on the needs of the school and available resources. The guidelines include recommendations related to the following eight aspects of school health efforts to prevent unintentional injury, violence, and suicide: a social environment that promotes safety; a safe physical environment; health education curricula and instruction; safe physical education, sports, and recreational activities; health, counseling, psychological, and social services for students; appropriate crisis and emergency response; involvement of families and communities; and staff development to promote safety and prevent unintentional injuries, violence, and suicide."The following CDC staff members prepared this report: Lisa C. Barrios, Margarett K. Davis, Laura Kann (National Center for Chronic Disease Prevention and Health Promotion (U.S.). Division of Adolescent and School Health),Sujata Desai, James A. Mercy, LeRoy E. Reese (National Center for Injury Prevention and Control (U.S.). Division of Violence Prevention), David A. Sleet (National Center for Injury Prevention and Control (U.S.). Division of Unintentional Injury Prevention), Daniel M. Sosin (Centers for Diseases Control and Prevention (U.S.). Epidemiology Program Office).Includes bibliographical references (p. 47-64).11770577Injury Prevention and ControlPrevention and ControlCurren

USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: a summary

"July 14, 1995."This issue of MMWR Recommendations and Reports (Vol. 44, No. RR-8) is excerpted from the USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus, to be published in a supplement to Clinical Infectious Diseases in August 1995.Prepared by Jonathan E. Kaplan, Henry Masur, King K. Holmes.Includes bibliographical references (p. 34)

Frequently asked questions about SARS

Severe acute respiratory syndrome (SARS) is a viral respiratory illness that was recognized as a global threat in March 2003, after first appearing in Southern China in November 2002.The Disease -- What is SARS? -- What are the symptoms and signs of SARS? -- What is the cause of SARS? -- How is SARS spread? -- What does close contact mean? -- If I were exposed to SARS-CoV, how long would it take for me to become sick? -- How long is a person with SARS contagious? -- Is a person with SARS contagious before symptoms appear? -- What medical treatment is recommended for patients with SARS? -- If there is another outbreak of SARS, how can I protect myself? -- -- Current SARS Situation, 2004 -- What is the current SARS situation in the world? -- -- SARS-associated coronavirus -- What are coronaviruses? -- If coronaviruses usually cause mild illness in humans, how could this new coronavirus be responsible for a potentially life-threatening disease such as SARS? -- How long can SARS-CoV survive in the environment? -- -- Laboratory Testing -- Is there a laboratory test for SARS? -- What is a PCR test? -- What does serologic testing involve? -- What does viral culture and isolation involve?April 26, 2004.Mode of access: Internet from the CDC web site as Acrobat .pdf file (173.82 KB, 4 p. )