HICNet Medical News Digest Mon, 23 May 1994 Volume 07 : Issue 21 Today's Topics: [MMWR 20 May 1994] Role of Media in Tobacco Control [MMWR] Cigarette Smoking Among Adults [MMWR] HIV Transmission in Household Settings [MMWR] Tornado Disaster FDA Reviews Antihistamine Mouse Study Institute of Tropical Medicine Epidemiological Bulletin +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Internet: mednews@stat.com Bitnet: ATW1H@ASUACAD Compilation Copyright 1994 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are interested in joining the automated distribution system, please contact the editor. Associate Editors: E. Loren Buhle, Jr. Ph.D. Dept. of Radiation Oncology, Univ of Pennsylvania Tom Whalen, M.D., Robert Wood Johnson Medical School at Camden Douglas B. Hanson, Ph.D., Forsyth Dental Center, Boston, MA Lawrence Lee Miller, B.S. Biological Sciences, UCI Dr K C Lun, National University Hospital, Singapore W. Scott Erdley, MS, RN, SUNY@UB School of Nursing Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Sun, 22 May 94 22:34:46 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR 20 May 1994] Role of Media in Tobacco Control Message-ID: Role of Media in Tobacco Control -- World No-Tobacco Day, 1994 The mass media have played an important role in efforts to control and prevent tobacco use. To recognize the effectiveness of these efforts, the theme of the seventh World No-Tobacco Day, to be held May 31, 1994, is "The Media and Tobacco: Getting the Health Message Across." Activities will include press releases, videotape presentations, educational symposia, and radio announcements by World Health Organization experts on tobacco control. The need for collaboration between public health workers and media representatives is particularly urgent in developing countries in which the prevalence of tobacco use is increasing. In these countries, the dissemination of information through the media also can assist in the development of educational and legislative measures to prevent and control tobacco use (1,2) and may help reduce the success of aggressive marketing campaigns by transnational tobacco companies. Examples of collaboration between the media and the tobacco-control groups in some countries include successful smoking-cessation and health-education campaigns (e.g., in Estonia, Finland, and New Guinea) and decisions by certain media to refuse cigarette advertising (e.g., in Australia, Canada, and the United States). Additional information about World No-Tobacco Day 1994 is available from the Office of Information and Public Affairs, Pan American Health Organization (telephone [202] 861-3458) or from CDC's Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion (telephone [404] 488-5705). References 1. World Health Organization. World No-Tobacco Day--31 May 1994 [Advisory kit]. Geneva: World Health Organization, 1994. 2. National Cancer Institute. Strategies to control tobacco use in the United States: a blueprint for public health action in the 1990's. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1991; DHHS publication no. (NIH)92-3316. ------------------------------ Date: Sun, 22 May 94 22:35:33 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] Cigarette Smoking Among Adults Message-ID: Cigarette Smoking Among Adults -- United States, 1992, and Changes in the Definition of Current Cigarette Smoking Use of tobacco in the United States is monitored continually by CDC to evaluate efforts to control and prevent the use of this substance. The prevalence of cigarette smoking among U.S. adults decreased from 1965 to 1990 (from 42.4% to 25.5%) and remained stable from 1990 to 1991 (from 25.5% to 25.6%) (1). To determine the prevalence of smoking among adults during 1992, the National Health Interview Survey-Cancer Control and Epidemiology Supplements (NHIS-CCES) collected self-reported information on cigarette smoking from a random sample of civilian, noninstitutionalized adults aged greater than or equal to 18 years. For 1992, the definition used to assess self-reported smoking prevalence was changed to more accurately assess some-day (i.e., intermittent) smoking because of a recognized higher prevalence of intermittent smoking (2). This report presents the prevalence estimates for 1992, compares findings with 1991, and assesses the impact of changes in the definition of current smoker on these estimates. The overall response rate for the 1992 NHIS-CCES (n=24,040) was 86.5%. For 1992, two nationally representative random samples from the NHIS-CCES were used to assess the new definition of current smoking status that included intermittent smoking. The Cancer Control Supplement (CCS) (n=12,035) asked, "Have you smoked at least 100 cigarettes in your entire life?" and "Do you smoke cigarettes now?" Persons who said they did not smoke now were asked, "Do you now smoke cigarettes not at all or some days?" Current smokers were defined as those who had smoked 100 cigarettes and smoked now; persons who said they did not smoke now but subsequently stated they smoked on some days were also classified as current smokers. The Cancer Epidemiology Supplement (CES) (n=12,005) asked, "Have you smoked at least 100 cigarettes in your entire life?" and "Do you now smoke cigarettes every day, some days or not at all?" Current smokers were defined as those who had smoked 100 cigarettes and now smoked either every day or some days. Data were adjusted for nonresponse and weighted to provide national estimates. Confidence intervals (CIs) were calculated using standard errors generated by the Software for Survey Data Analysis (SUDAAN) (3). Because the first two questions were the same for the 1991 NHIS-Health Promotion and Disease Prevention supplement and the 1992 CCS, these findings were compared directly. The overall prevalence of cigarette smoking among adults (25.6%) was the same in 1991 and 1992 (Table 1). The 1992 estimates that incorporated some-day smoking (CCS and CES) also were compared with 1991 and 1992 estimates based on the original definition. Estimates for both sets of definitions that incorporated an assessment of some-day smoking in 1992 were similar (CCS=26.7% and CES=26.3%) (Table 1). Because of the comparability of methods (i.e., assessing some-day smoking), results were combined to provide an overall prevalence estimate for 1992. Based on the inclusion of intermittent smoking, the prevalence of smoking increased by 0.9% (from 25.6% to 26.5%) (Table 1). In 1992, an estimated 48 million (26.5% [95% CI=plus or minus 0.5%]) adults in the United States were current smokers, reflecting prevalences of daily smoking of 22.1% (95% CI=plus or minus 0.5%) and some-day smoking of 4.4% (95% CI=plus or minus 0.2%). Smoking prevalence was highest among persons aged 25-44 years (30.8% [95% CI=plus or minus 0.8%]). Smoking prevalence was highest among American Indians/Alaskan Natives (39.4% [95% CI=plus or minus 6.0%]) and lowest among Asians/Pacific Islanders (15.2% [95% CI= plus or minus 3.6%]), declined with increasing levels of education, and was highest among persons who lived below the poverty level* (34.9% [95% CI=plus or minus 1.5%]). Approximately 25 million men (28.6% [95% CI=plus or minus 0.8%]) and 23 million women (24.6% [95% CI=plus or minus 0.7%]) were current smokers (Table 2). For most demographic groups, smoking prevalence was higher among men than women. Using the original definition of current smoking, smoking prevalence was the same in 1991 and 1992 overall, for both men and women, for all racial/ethnic groups, for all educational levels, and for persons with incomes above the poverty level (Table 1). Smoking prevalence was significantly higher in 1992 (37.0% [95% CI= plus or minus 2.1%]) than in 1991 (33.1% [95% CI=plus or minus 1.5%]) among persons living below the poverty level. However, among persons with incomes below the poverty level, there were substantial differences in smoking prevalence as measured by the two question formats that included some-day smokers. As a result, the combined prevalence estimate for 1992 was not significantly different from the 1991 estimate. Reported by: Surveillance Program, National Cancer Institute. National Institutes of Health. Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Health Interview Statistics, National Center for Health Statistics, CDC. Editorial Note: The findings in this report indicate that the estimated prevalence of smoking in 1992 was the same as in 1991 overall and for most demographic groups. In addition, these findings indicate that including some-day smoking in the definition of current smoking will increase the prevalence estimate by approximately 1.0%. The definition used in the 1992 CES will become the standard for CDC efforts to measure smoking prevalence in the United States. The inclusion of intermittent smoking improves both the accuracy and precision of the definition of current smoking and facilitates efforts to monitor changes in current smoking status. Based on use of the original definition of current smoker, which did not assess some-day smoking, the prevalence of smoking in 1992 was significantly higher than in 1991 among persons living below the poverty level. This finding was attributable to a substantial increase in the prevalence of smoking among women who live below the poverty level and to a smaller increase among men. The impact of changes in the question format that incorporated an assessment of some-day smoking substantially altered the prevalence estimates for persons living below the poverty level. Specifically, in the CCS survey--which used a two-part question to assess some-day smoking--smoking prevalence increased among persons living below the poverty level. In comparison, in the CES survey--which used a single question to assess some-day smoking--there was no change in smoking prevalence. For the first time since 1983, smoking prevalence among persons aged 18-24 years did not decrease. Factors that may have contributed to the stabilization include the steady growth in market share of discount cigarettes (4) and the $4.6 billion in advertising and promotional expenditures by tobacco companies during 1991--a 16% increase in expenditures when compared with 1990 (5,6). Efforts to address smoking among young persons have included the 1994 Surgeon General's report (6) and a companion report for adolescents. In addition, CDC has published school guidelines for incorporating tobacco-use prevention and tobacco-cessation strategies (7). The findings in this report are subject to at least two limitations. First, the prevalence estimate for 1992 was based on information collected from January through July 1992. In comparison, a different survey that collected data for the entire year indicated that smoking prevalence among adults declined in the second half of the year (Substance Abuse and Mental Health Services Administration, unpublished data, 1992), a finding consistent with a 3% per capita decrease in consumption of cigarettes in 1992 (8). Second, differences in prevalence among racial/ethnic groups may be influenced by differences in educational levels and socioeconomic status, as well as by social and cultural phenomena that require further explanation. Acceleration of the decline in smoking prevalence will require intensified efforts to discourage the use of tobacco by helping smokers break the addiction to nicotine, persuading children to never initiate smoking, and enacting public policies that discourage smoking. Examples of such policies include increasing taxes on tobacco products, enforcing minors'-access laws, restricting smoking in public places, and restricting tobacco advertising and promotion. In January 1994, for the first time, all 50 states and the District of Columbia were receiving public funds for tobacco-control activities: 49 states and the District of Columbia were receiving federal funds, and California was receiving state funds. References 1. NCHS. Health, United States, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. 2. Evans NJ, Gilpin E, Pierce JP, et al. Occasional smoking among adults: evidence from the California Tobacco Survey. Tobacco Control 1992;1:169-75. 3. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.50 [Software documentation]. Research Triangle Park, North Carolina: Research Triangle Institute, 1991. 4. Maxwell JC Jr. The Maxwell consumer report: 1992 year-end and fourth-quarter sales estimates for the cigarette industry. Richmond, Virginia: Butcher and Singer, February 10, 1993; publication no. WFBS-6983. 5. US Federal Trade Commission. Federal Trade Commission report to Congress for 1991: pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, DC: US Federal Trade Commission, 1994. 6. US Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994. 7. CDC. Guidelines for school health programs to prevent tobacco use and addiction. MMWR 1994;43(no. RR-2). 8. US Department of Agriculture. Tobacco situation and outlook report. Washington, DC: US Department of Agriculture, Economic Research Service, Commodity Economics Division, April 1994; publication no. TBS-226. * Poverty statistics are based on definitions originated by the Social Security Administration in 1964, subsequently modified by federal interagency committees in 1969 and 1980, and prescribed by the Office of Management and Budget as the standard to be used by federal agencies for statistical purposes. ------------------------------ Date: Sun, 22 May 94 22:36:33 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] HIV Transmission in Household Settings Message-ID: Human Immunodeficiency Virus Transmission in Household Settings -- United States Transmission of human immunodeficiency virus (HIV) has been reported in homes in which health care has been provided and between children residing in the same household (1-6). CDC has received reports of two cases of HIV infection that apparently occurred following mucocutaneous exposures to blood or other body substances in persons who received care from or provided care to HIV-infected family members residing in the same household. This report summarizes the findings of the epidemiologic and laboratory investigations, which underscore the need to educate persons who care for or are in contact with HIV-infected persons in household settings where such exposures may occur.* Patient 1 A 5-year-old child whose parents were both HIV-infected tested negative for HIV antibody in 1990 and July 1993 but tested positive in December 1993. In February 1994, all other close household contacts of the child tested HIV-antibody negative. From January through December 1993, when the child was likely to have become infected, the child's parents were the only known HIV-infected persons with whom the child had any contact. During this period, the child lived with both parents until the father's death as the result of acquired immunodeficiency syndrome (AIDS) in May 1993. The child continued to live with the mother, who had AIDS, until 8 days before the child's last negative antibody test in July 1993. The child then lived in foster care. The child had several opportunities for contact with HIV-infected blood and exudative skin lesions. Based on the mother's medical records and history, from March through August 1993 the mother had recurrent, purulent, exudative skin lesions (diagnosed as prurigo nodularis) on her face, neck, torso, buttocks, and extremities. She frequently scratched the lesions until they bled, left the lesions uncovered, and discarded onto the furniture or the floor the gauze and tissues used to wipe the exudate. During periods when the mother's skin lesions were uncovered and draining, the child frequently hugged and slept with the mother. In addition, the child intermittently had scabs from impetigo and abrasions that the mother sometimes picked off and caused to bleed. When the mother had intermittent gingival bleeding, she periodically shared a toothbrush with the child. From January through May 1993, the child had no known contact with the father's blood or body fluids, although the child sometimes used his toothbrush. No other situations were identified in which the child potentially may have been exposed to HIV-infected blood or had contact with an HIV-infected person. There were no known HIV-infected persons in either the foster home or the school, and the child had no known contact with blood in these settings. Based on interviews and medical record reviews, no household members at either the parents' home or foster home engaged in injecting-drug use. Based on history and physical examination, sexual abuse of the child was believed to be unlikely. During 1993, the child had no injections, blood transfusions, vaccinations, or invasive dental or medical procedures. Proviral DNA from peripheral blood mononuclear cells obtained from the mother and the child was amplified by polymerase chain reaction. By direct sequencing, the two DNA fragments encompassing 343 nucleotides of the V3 and flanking regions of the gene encoding the HIV-1 envelope glycoprotein (gp120) were genetically similar, differing by only 2.6%. No specimen was available from the child's father. Patient 2 In August 1991, a 75-year-old woman was evaluated because of fatigue and malaise and tested positive for HIV antibody; her adult son died in August 1990 as the result of AIDS. Her CD4+ T-lymphocyte count was 837 cells/uL. She had been married for approximately 50 years; her husband tested negative for HIV antibody. The patient reported no other sex partners and denied all risk factors for HIV infection, including injecting-drug use and receipt of blood or blood products since 1978; she had not been employed in a health-care setting. The woman had a cholecystectomy in December 1990; in February 1992, all members of the surgical team tested negative for HIV antibody. Her son had lived in the household from September 1989 until his death. He initially was able to care for himself; however, in July 1990 (6 weeks before his death), his mother began to provide daily nursing care for him (e.g., bathing, feeding, changing diapers, and repositioning his urinary catheter). Although she had been informed of the need to wear gloves while providing such care, she reported inconsistent adherence to this recommendation. She could not recall any direct exposures to her son's blood. Her son did not require intravenous fluids or medication in the home nor did he have an intravascular device. No needles or other sharp instruments related to his care were in the home. Dermatologic conditions had not been noted. The son had hemorrhoids and diarrhea, but neither visible blood nor melena had been noticed at home. The mother reported skin contact with her son's feces on at least one occasion. While hospitalized in February 1990, he had upper gastrointestinal bleeding; endoscopy revealed chronic gastritis and duodenitis. During hospitalization in June 1990, he had an episode of lower gastrointestinal bleeding. No such bleeding episodes occurred at home. The son had poor dentition and gingivitis around his upper molars, and his mother frequently handled the cotton-tipped swabs her son used for his oral hygiene care, although she attempted to avoid touching the cotton tips with bare hands. She reported having infrequent small cuts on her hands but had no history of dermatitis or other skin lesions. There were no blood specimens available from the son for HIV DNA sequencing. Reported by: Div of HIV/AIDS and Hospital Infections Program, National Center for Infectious Diseases, CDC. Editorial Note: The findings of the investigations described in this report indicate the transmission of HIV as the result of contact with blood or other body secretions or excretions from an HIV-infected person in the household. In both instances, exposures occurred after the source-patients had developed AIDS; consequently, relatively high HIV titers may have been present in their blood. For patient 1, who had had direct exposure to purulent and bloody exudates from the mother's open skin lesions, transmission may have been facilitated by the child's broken skin and the mother's manipulation of the child's skin lesions. Patient 2 most likely became infected while providing nursing care for her son. Although the precise mode of transmission is unknown, she had direct contact with her son's urine and feces; because of his chronic gastritis and duodenitis, some blood could have been present in his feces, even though the blood was inapparent to his mother. In addition, she could have had other unrecognized or unrecalled exposures to her son's blood. Even though previous reports have documented HIV transmission as the result of skin or mucous-membrane exposure to HIV-infected blood, HIV is not easily transmitted by this route. Based on assessment of health-care workers exposed to HIV-infected blood, the risk for HIV transmission has been estimated to be less than 0.1% for a single mucous-membrane exposure (95% confidence interval=0.006-0.50) (7). The risk is probably lower for skin exposures to HIV-infected blood and even lower, if present at all, for skin exposures to body secretions and excretions without visible blood (7,8). Although previous reports document that HIV has been isolated from urine (9) and that HIV nucleic acid--but not infectious HIV--has been detected in feces (10), transmission of HIV by urine or feces has not been reported. Although contact with blood and other body substances can occur in households, transmission of HIV is rare in this setting. In addition to the two patients in this report, six previous reports have described household transmission of HIV not associated with sexual contact, injecting-drug use, or breast feeding (Table 1). Of these eight reports, five were associated with documented or probable blood contact ([1,3-5] and patient 1 in this report). In the sixth report, HIV infection was diagnosed in a boy after his younger brother had died as the result of AIDS; however, a specific mechanism of transmission was not determined (6). Two reports involved nursing care of terminally ill persons with AIDS in which a blood exposure might have occurred but was not documented ([2] and patient 2 in this report); in both reports, skin contact with body secretions and excretions occurred. Persons who provide nursing care for HIV-infected patients in home settings should employ precautions to reduce exposures to blood and other body fluids (11). In particular, needles and sharp objects contaminated with blood should be handled with care. Needles should not be recapped by hand or removed from syringes. Needles and sharp objects should be disposed of in puncture-proof containers, and the containers should be kept out of reach of children and visitors. Bandages should be used to cover cuts, sores, or breaks on exposed skin of persons with HIV infection and of persons providing care. In addition, persons who provide such care should wear gloves when there is a possibility of direct contact with HIV-infected blood or other body fluids, secretions, or excretions. Because urine and feces may contain a variety of pathogens, including HIV, persons providing nursing care to HIV-infected persons should wear gloves during contact with these substances. In addition, even when gloves are worn, hands should be washed after contact with blood and other body fluids, secretions, or excretions. Because of the social, economic, and medical benefits of home care, the number of persons with AIDS who receive health care outside of hospitals is increasing. Persons infected with HIV and persons providing home care for those who are HIV-infected should be fully educated and trained regarding appropriate infection-control techniques. In addition, health-care providers should be aware of the potential for HIV transmission in the home and should provide training and education in infection control for HIV-infected persons and those who live with or provide care to them in the home. Such training should be an integral and ongoing part of the health-care plan for every person with HIV infection. Additional infection-control recommendations are contained in a recently updated brochure published by CDC, Caring for Someone with AIDS: Information for Friends, Relatives, Household Members, and Others Who Care for a Person With AIDS at Home. This brochure is available free in English or Spanish from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; telephone (800) 458-5231 or (301) 217-0023. References 1. CDC. Apparent transmission of human T-lymphotrophic virus type III/lymphadenopathy-associated virus from a child to a mother providing health care. MMWR 1986;35:76-9. 2. Grint P, McEvoy M. Two associated cases of the acquired immunodeficiency syndrome (AIDS). Communicable Disease Report 1985;42:4. 3. CDC. HIV infection in two brothers receiving intravenous therapy for hemophilia. MMWR 1992;41:228-31. 4. Fitzgibbon JE, Gaur S, Frenkel LD, et al. Transmission from one child to another of human immunodeficiency virus type 1 with a zidovudine-resistance mutation. N Engl J Med 1993;329: 1835-41. 5. CDC. HIV transmission between two adolescent brothers with hemophilia. MMWR 1993;42:948-51. 6. Wahn V, Kramer HH, Voit T, Bruster HT, Scrampical B, Scheid A. Horizontal transmission of HIV infection between two siblings [Letter]. Lancet 1986;2:694. 7. Ippolito G, Puro V, De Carli G, Italian Study Group on Occupational Risk of HIV Infection. The risk of occupational human immunodeficiency virus infection in health care workers: Italian Multicenter Study. Arch Intern Med 1993;153:1451-8. 8. Henderson DK, Fahey BJ, Willy M, et al. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: a prospective evaluation. Ann Intern Med 1990;113:740-6. 9. Levy JA. Pathogenesis of human immunodeficiency virus infection. Microbiol Rev 1993;57:183-289. 10. Yolken RH, Li S, Perman J, Viscidi R. Persistent diarrhea and fecal shedding of retroviral nucleic acids in children infected with human immunodeficiency virus. J Infect Dis 1991;164:61-6. 11. CDC. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987;36(no. 2S). * Single copies of this report will be available free until May 20, 1995, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; telephone (800) 458-5231 or (301) 217- 0023. ------------------------------ Date: Sun, 22 May 94 22:37:15 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] Tornado Disaster Message-ID: Tornado Disaster -- Alabama, March 27, 1994 On Sunday, March 27, 1994, a series of severe thunderstorms and tornadoes moved across Alabama, Tennessee, Georgia, North Carolina, and South Carolina. These storms accounted for injuries to at least 422 persons, including 47 fatalities. Twenty-three fatalities were associated with a tornado that cut a path across St. Clair, Calhoun, and Cherokee counties in northeastern Alabama from 10:55 a.m. to 11:39 a.m. (Figure 1). This tornado damaged or destroyed three churches while services were being conducted. This report provides a summary of the injuries and deaths associated with this tornado based on information from death certificates from coroners' offices in the three counties and from emergency department and inpatient medical records from eight area hospitals. Of 144 persons who sustained nonfatal injuries and sought hospital-based medical care, 87 (60%) were treated and released; primary diagnoses included contusions/ abrasions (39 [45%]), lacerations (27 [31%]), fractures (six [7%]), and other trauma (15 [17%]). Fifty-seven (40%) persons were hospitalized; primary diagnoses included fractures (23 [40%]), multiple trauma (12 [21%]), head trauma (10 [18%]), and other trauma (12 [21%]). Twenty of the 23 deaths occurred when the tornado destroyed a church in southern Cherokee County (Table 1). Two persons were killed while inside automobiles, and one died outdoors at a boat ramp. The mean age of the decedents was 35 years (range: 2-79 years). The immediate cause of death for 22 persons was severe head trauma with multiple injuries; for one person, the cause was hemorrhagic shock with multiple trauma. The National Weather Service issued severe thunderstorm warnings for eastern Jefferson and St. Clair counties at 10:24 a.m. and issued a tornado warning for Etowah and Calhoun counties at 10:49 a.m. The tornado warnings broadcast over radio and television advised persons to seek immediate shelter. At 10:53 a.m., local television and radio stations broadcast a tornado warning for St. Clair County. At 10:55 a.m., the tornado struck southwest of Ragland in St. Clair County. At 11:27 a.m., a revised tornado warning was issued for northern Calhoun, southeastern Etowah, and southern Cherokee counties. At 11:39 a.m., the church in Cherokee County, approximately 32 miles northeast of the tornado's initial point of impact, was destroyed. The tornado's path was one fourth to one half mile wide and approximately 50 miles long. Because of its extremely rapid development and rapid ground speed (60 mph), this tornado was sighted only 5 minutes before it touched down, despite use of Doppler radar. Reported by: R Curley, Jacksonville Hospital, Jacksonville; L Ramsey, Northeast Alabama Regional Medical Center, L Burdette, Stringfellow Memorial Hospital, JL Bennett, Calhoun County Emergency Management Agency, P Hulsey, Calhoun County Coroner, Anniston; L Doeg, Cherokee Baptist Medical Center, L Tucker, Cherokee County Coroner, Centre; D Norrell, Baptist Medical Center- De Kalb, Fort Payne; D Brittian, Gadsden Regional Medical Center, C Turner, Riverview Regional Medical Center, Gadsden; S Evans, St. Clair Regional Hospital, J Wyatt, St. Clair County Coroner, Pell City; TR Nielsen, L Burell, Public Health Area IV, Anniston; CH Woernle, MD, State Epidemiologist, Alabama Dept of Public Health. B Peters, National Weather Svc, Huntsville, Alabama. Disaster Assessment and Epidemiology Section, Health Studies Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Chronic Disease Prevention Br, Div of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial Note: Tornadoes are one of the most lethal and violent of all natural disasters; in the United States during 1953-1992, tornadoes accounted for 3653 fatalities (1). Tornadoes have occurred in every state and during every month of the year (2). The Fujita Tornado Scale (F0-F6) ranks tornadoes according to their speed, path length, and path width. The March 27 tornado was ranked as a Fujita level 4, which is among the top 3% of the most violent tornadoes. Local implementation of prevention and control measures in conjunction with tornado "watches" and "warnings" issued by the National Weather Service (3,4) include the establishment of local observer networks, installation of warning systems (e.g., alarms or sirens), and education of the public about when and where to take shelter (4). Previous investigations have suggested an increased risk for injury or death among persons who are inside mobile homes or vehicles when tornadoes strike (3-6). The findings in Alabama suggest that persons inside some public buildings also may be at risk. The findings also emphasize the role of local observer networks in providing timely warnings to communities in the projected path of a tornado. Additional measures include alarms, sirens, or warning devices that are not dependent on radio or television broadcast and can be activated when National Weather Service tornado warnings are issued or when local public safety authorities note the approach of severe weather. The National Oceanic and Atmospheric Administration recommends the following prevention measures for persons in areas in which tornado warnings have been issued: 1) persons in permanent homes should go to a basement, hallway, closet, or interior room and cover themselves with pillows, blankets, or mattresses; 2) persons in mobile homes should seek shelter in a permanent structure (mobile home tiedowns are ineffective at wind speeds above 50 mph); 3) in rural areas, persons in vehicles should leave their vehicles and lie flat in the nearest gully or ditch; and 4) in urban areas, persons in vehicles should leave their vehicles and seek shelter in a permanent structure, and persons in buildings without basements should go to a small interior room or hallway (4). References 1. National Climatic Data Center. Storm data and unusual weather phenomena, with late reports and corrections. Asheville, North Carolina: National Oceanic and Atmospheric Administration, National Climatic Data Center, 1992;34(12):90. 2. Fujita TT. U.S. tornadoes, part one: 70-year statistics. Chicago: The University of Chicago, Department of Geophysical Sciences, 1987:103. 3. CDC. Tornado disaster--Kansas, 1991. MMWR 1992;41:181-3. 4. Sanderson LM. Tornadoes. In: Gregg MB, ed. The public health consequences of disasters, 1989. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1989:39-49. 5. CDC. Tornado disaster--Illinois, 1990. MMWR 1991;40:33-6. 6. Glass RI, Craven RB, Bregman DJ, et al. Injuries from the Wichita Falls tornado: implications for prevention. Science 1980;207:734-8. ------------------------------ Date: Sun, 22 May 94 22:38:10 MST From: mednews (HICNet Medical News) To: hicnews Subject: FDA Reviews Antihistamine Mouse Study Message-ID: FDA Reviews Antihistamine Mouse Study May 17, 1994 --- ------- ------------- ----- ----- --- --- ---- FDA has received inquiries about a study published in the May 18, l994, Journal of the National Cancer Institute that suggests the antihistamines loratidine, astemizole and hydroxyzine act to stimulate the growth of tumors transplanted into mice. The authors, at the Manitoba Institute of Cell Biology at the University of Manitoba in Canada, had previously published a paper suggesting that certain antidepressants accelerate the growth of existing tumors in mice. FDA has been following these reports. The agency believes that further study is needed to determine whether these kinds of animal data suggest a potential concern for human use of the drugs. No clinical data support the findings, and standard carcinogenicity studies with loratidine and astemizole in mice and rats do not demonstrate carcinogenicity. The agency does not believe, therefore, that changes in the drugs' labeling or approval status are warranted. FDA is advising consumers that short term use is not at issue. Loratidine, astemizole and hydroxyzine are prescription drugs used for relief of hay fever, allergies and itching. FDA is attempting to duplicate the results of the reported animal studies and is evaluating the feasibility of epidemiologic studies in patients with cancer. In addition, FDA will conduct studies to examine whether additional types of tumors show a similar response when transplanted in animals. The agency also is working with the article's authors to obtain additional data. ------------------------------ Date: Mon, 23 May 94 06:34:17 MST From: mednews (HICNet Medical News) To: hicnews Subject: Institute of Tropical Medicine Epidemiological Bulletin Message-ID: IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.11 Date: 03/19/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 03/19/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER * 1 6 9 SHIGELLOSIS 21 5 45 49 AMEBIAN D. 160 11 1277 90 TUBERCULOSIS 11 14 136 162 HANSEN DISEASE 7 4 33 23 PERTUSSIS 4 * 4 * SCARLET FEVER 9 4 104 75 MENINGOCOCCAL M.(1) 0 2 12 12 MENINGOCCEMIES(1) * 1 3 2 TETANUS * * * * VIRAL M. 65 65 523 916 BACTERIAL M. 31 33 292 283 VARICELLA 1859 1226 11948 9897 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 375 376 3630 2932 MUMPS * * * * MALARIA * * 2 12 LEPTOSPIROSIS 6 13 79 209 SYPHILIS 201 205 2072 2337 GONORRHEA 398 451 4417 5035 ACUMINATA COND. 25 38 432 360 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Notified Outbreaks. Week 03/17/94 - 03/23/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ A.D.D. 1 49 PROV. HABANA ------------------------------------------------------------ F.T.D. 10 251 MATANZAS 1/3 CIENFUEGOS 1/16 CAMAGUEY 3/105 HOLGUIN 2/73 GRANMA 1/28 GUANTANAMO 2/26 ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 85% of provinces- days-information. The offered indexes are provisionals and were taken from the daily report of the Direct Information System (DIS) remitted by Provincial Centers of Hygiene and Epidemiology, from the weekly phone report of Mandatory Notifiable Diseases (MND) remitted by National Statistics Division of the Ministry of Public Health, and from the Reference Laboratories of the Institute of Tropical Medicine Pedro Kouri. ------------------------------------------------------------ This is the weekly IPK-Epidemiological Bulletin emitted via Electronic Mail. The numbering plan agree with the IPK-Epidemiological Bulletin edited by Institute of Tropical Medicine Pedro Kouri and it is an abbreviated version. Lic. Andres M. Alonso ipk-b@infomed.cu IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.12 Date: 03/26/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 03/26/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER * 4 6 13 SHIGELLOSIS 16 1 82 50 AMEBIAN D. 159 1 1436 91 TUBERCULOSIS 10 21 146 183 HANSEN DISEASE 6 6 39 29 PERTUSSIS * * 4 * SCARLET FEVER 13 15 117 90 MENINGOCOCCAL M.(1) 4 1 17 13 MENINGOCCEMIES(1) 1 * 4 2 TETANUS * * * * VIRAL M. 41 86 564 1002 BACTERIAL M. 11 24 303 307 VARICELLA 2365 1878 14313 11775 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 360 318 3990 3250 MUMPS * * * * MALARIA * 1 2 2 LEPTOSPIROSIS 14 12 93 221 SYPHILIS 162 221 2234 2558 GONORRHEA 319 529 4736 5564 ACUMINATA COND. 59 43 491 403 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Notified Outbreaks. Week 03/24/94 - 03/30/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ A.D.D. 1 40 SANCTI SPIRITUS ------------------------------------------------------------ F.T.D. 4 103 MATANZAS 1/1 VILLA CLARA 2/98 CIEGO DE AVILA 1/4 ------------------------------------------------------------ VIRAL HEP. 1 2 CIENFUEGOS ------------------------------------------------------------ VARICELLA 2 9 PROV.HABANA 1/4 HOLGUIN 1/5 ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 64% of provinces-days- information. The offered indexes are provisionals and were taken from the daily report of the Direct Information System (DIS) remitted by Provincial Centers of Hygiene and Epidemiology, from the weekly phone report of Mandatory Notifiable Diseases (MND) remitted by National Statistics Division of the Ministry of Public Health, and from the Reference Laboratories of the Institute of Tropical Medicine Pedro Kouri. ------------------------------------------------------------ This is the weekly IPK-Epidemiological Bulletin emitted via Electronic Mail. The numbering plan agree with the IPK-Epidemiological Bulletin edited by Institute of Tropical Medicine Pedro Kouri and it is an abbreviated version. Lic. Andres M. Alonso ipk-b@infomed.cu IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.13 Date: 04/02/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 04/02/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER * 1 6 14 SHIGELLOSIS 5 1 66 51 AMEBIAN D. 6 15 1442 66 TUBERCULOSIS 20 17 166 200 HANSEN DISEASE 2 3 41 32 PERTUSSIS * * 4 * SCARLET FEVER 9 9 126 99 MENINGOCOCCAL M.(1) 3 * 20 13 MENINGOCCEMIES(1) * * 4 2 TETANUS * * * * VIRAL M. 54 80 618 1082 BACTERIAL M. 14 40 317 347 VARICELLA 2495 2254 16808 14029 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 399 418 4389 3668 MUMPS * * * * MALARIA * * 2 1 LEPTOSPIROSIS 19 23 112 244 SYPHILIS 210 219 2444 2777 GONORRHEA 459 581 5195 6145 ACUMINATA COND. 38 33 529 435 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Notified Outbreaks. Week 03/31/94 - 04/06/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ A.D.D. 2 45 SANTIAGO DE CUBA ------------------------------------------------------------ F.T.D. 11 290 GRANMA 1/14 VILLA CLARA 2/95 CAMAGUEY 6/118 HOLGUIN 2/63 ------------------------------------------------------------ VIRAL HEP. 2 137 SANTIAGO DE CUBA ------------------------------------------------------------ T.B. 1 3 HOLGUIN ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 71% of provinces-days- information. The offered indexes are provisionals and were taken from the daily report of the Direct Information System (DIS) remitted by Provincial Centers of Hygiene and Epidemiology, from the weekly phone report of Mandatory Notifiable Diseases (MND) remitted by National Statistics Division of the Ministry of Public Health, and from the Reference Laboratories of the Institute of Tropical Medicine Pedro Kouri. ------------------------------------------------------------ This is the weekly IPK-Epidemiological Bulletin emitted via Electronic Mail. The numbering plan agree with the IPK-Epidemiological Bulletin edited by Institute of Tropical Medicine Pedro Kouri and it is an abbreviated version. Lic. Andres M. Alonso ipk-b@infomed.cu IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.14 Date: 04/09/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 04/09/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER 1 * 7 14 SHIGELLOSIS 16 4 82 55 AMEBIAN D. 12 5 1454 71 TUBERCULOSIS 9 24 175 224 HANSEN DISEASE 10 8 51 40 PERTUSSIS * * 4 * SCARLET FEVER 6 8 132 107 MENINGOCOCCAL M.(1) 1 5 25 22 MENINGOCCEMIES(1) * * 4 4 TETANUS * * * * VIRAL M. 49 54 667 1136 BACTERIAL M. 21 19 338 366 VARICELLA 2201 1733 19009 15762 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 322 420 4711 4088 MUMPS * * * * MALARIA * * 2 1 LEPTOSPIROSIS 9 19 121 263 SYPHILIS 164 224 2608 3001 GONORRHEA 367 518 5562 6663 ACUMINATA COND. 42 57 571 492 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Notified Outbreaks. Week 04/07/94 - 04/13/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ A.D.D. 4 223 PROV.HABANA 1/6 VILLA CLARA 1/66 CIEGO DE AVILA 2/151 ------------------------------------------------------------ F.T.D. 4 45 MATANZAS 1/1 HOLGUIN 2/31 GUANTANAMO 1/13 ------------------------------------------------------------ VIRAL HEP. 1 133 VILLA CLARA ------------------------------------------------------------ VARICELLA 1 5 PROV.HABANA ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 70% of provinces-days- information. The offered indexes are provisionals and were taken from the daily report of the Direct Information System (DIS) remitted by Provincial Centers of Hygiene and Epidemiology, from the weekly phone report of Mandatory Notifiable Diseases (MND) remitted by National Statistics Division of the Ministry of Public Health, and from the Reference Laboratories of the Institute of Tropical Medicine Pedro Kouri. ------------------------------------------------------------ This is the weekly IPK-Epidemiological Bulletin emitted via Electronic Mail. The numbering plan agree with the IPK-Epidemiological Bulletin edited by Institute of Tropical Medicine Pedro Kouri and it is an abbreviated version. Lic. Andres M. Alonso ipk-b@infomed.cu IPK - EPIDEMIOLOGICAL BULLETIN Vol 4e / No.15 Date: 04/16/94 Institute of Tropical Medicine Pedro Kouri National Epidemiology Office Ministry of Public Health ------------------------------------------------------------ Cuba. Cases and Cumulative of selected notifiable diseases. Week ending 04/16/94. ------------------------------------------------------------ DISEASES IN THIS WEEK CUMULATIVE 1992 1993 1992 1993 ------------------------------------------------------------ TYPHOID FEVER 1 * 7 14 SHIGELLOSIS 2 * 84 55 AMEBIAN D. 19 4 1473 115 TUBERCULOSIS 14 13 183 237 HANSEN DISEASE 3 6 54 46 PERTUSSIS * * 4 * SCARLET FEVER 8 2 140 109 MENINGOCOCCAL M.(1) 4 2 25 22 MENINGOCCEMIES(1) * 2 4 4 TETANUS * * * * VIRAL M. 39 64 706 1200 BACTERIAL M. 7 29 345 395 VARICELLA 1676 1427 20685 17189 MEASLES * * * * RUBELLA * * * * VIRAL HEPATITIS 355 414 5066 4502 MUMPS * * * * MALARIA * * 2 1 LEPTOSPIROSIS 7 1 128 264 SYPHILIS 167 221 2775 3222 GONORRHEA 323 519 5885 7182 ACUMINATA COND. 55 45 626 538 ------------------------------------------------------------ Source: 1993, MND (Written Report) EIG-IPK. 1994, MND (Phone Report) EIG-IPK. (1) DIS * Means 0 reported case. Notified Outbreaks. Week 04/07/94 - 04/13/94. ------------------------------------------------------------ DISEASES OUTBREAKS CASES PROVINCES ------------------------------------------------------------ A.D.D. 1 129 PINAR DEL RIO ------------------------------------------------------------ F.T.D. 3 122 SANCTI SPIRITUS 1/59 VILLA CLARA 2/63 ------------------------------------------------------------ VIRAL HEP. 1 5 PINAR DEL RIO ------------------------------------------------------------ CHEMICAL INT. 1 14 PROV.HABANA ------------------------------------------------------------ Source: DIS. ------------------------------------------------------------ This bulletin was prepared with the 75% of provinces-days- information. The offered indexes are provisionals and were taken from the daily report of the Direct Information System (DIS) remitted by Provincial Centers of Hygiene and Epidemiology, from the weekly phone report of Mandatory Notifiable Diseases (MND) remitted by National Statistics Division of the Ministry of Public Health, and from the Reference Laboratories of the Institute of Tropical Medicine Pedro Kouri. ------------------------------------------------------------ This is the weekly IPK-Epidemiological Bulletin emitted via Electronic Mail. The numbering plan agree with the IPK-Epidemiological Bulletin edited by Institute of Tropical Medicine Pedro Kouri and it is an abbreviated version. Lic. Andres M. Alonso ipk-b@infomed.cu ------------------------------ End of HICNet Medical News Digest V07 Issue #21 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD -------------------------------------------------------------------------------