HICNet Medical News Digest Wed, 18 Jan 1995 Volume 08 : Issue 03 Today's Topics: [MMWR 23 Dec 94] Cigarette Smoking Among Adults [MMWR] Abortion Surveillance - Preliminary Data [MMWR] Trends Among Women Who Did Not Receive Prenatal Care [MMWR] Bolivian Hemorrhagic Fever CancerNet Update for January, 1995 Q&A About AIDS Saliva Test Clinical Alert - Ischemic Optic Neuropathy Decompression Trial Findings +------------------------------------------------+ ! ! ! 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 Mosaic WWW *Asia/Pacific: http://biomed.nus.sg/MEDNEWS/welcome.html *Americas: http://cancer.med.upenn.edu:3000/ *Europe: http:/www.dmu.ac.uk/0/departments/pharmacy/archive/www/MEDNEWS/welcome .html 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 Jack E. Cross, B.S Health Care Admin, 882 Medical Trng Grp, USAF Albert Shar, Ph.D. CIO, Associate Prof, Univ of Penn School of Medicine Martin I. Herman, M.D., LeBonheur Children's Medical Center, Memphis TN Stephen Cristol, M.D. MPH, Dept of Ophthalmology, Emory Univ, Atlanta, GA Subscription Requests = mednews@stat.com anonymous ftp = vm1.nodak.edu; directory HICNEWS FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Wed, 18 Jan 95 06:51:02 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR 23 Dec 94] Cigarette Smoking Among Adults Message-ID: Cigarette Smoking Among Adults -- United States, 1993 The annual prevalence of cigarette smoking among adults in the United States declined 40% during 1965-1990 (from 42.4% to 25.5%) (1) but was virtually unchanged during 1990-1992 (2). To determine the prevalence of smoking among adults, smoker interest in quitting, and the prevalence of cessation (i.e., quit ratio) among adults during 1993, the Year 2000 Health Objectives Supplementof the 1993 National Health Interview Survey (NHIS-2000) collected self-reported information about cigarette smoking from a random sample of civilian, noninstitutionalized adults aged greater than or equal to 18 years. This report presents the prevalence estimates for 1993 and compares them with estimates from the 1992 Cancer Epidemiology Supplement and presents 1993 estimates for smoker interest in quitting completely and the prevalence of cessation among ever smokers. The overall response rate for the 1993 NHIS-2000 (n=20,860) was 81.2%. For 1993, current smoking status was determined through two questions: "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?" Ever smokers were persons who reported having smoked at least 100 cigarettes during their entire lives. Current smokers were defined as those who had smoked 100 cigarettes and now smoked either every day (i.e., daily smokers) or some days (i.e., some-day smokers). Former smokers had smoked at least 100 cigarettes in their lives but did not currently smoke. The prevalence of cessation was the percentage of former smokers among ever smokers. Interest in quitting smoking was assessed using answers to the question "Would you like to completely stop smoking cigarettes?" 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). Prevalence estimates for 1992 were based on two definitions of current smoking and were calculated by averaging the estimates generated by each definition (2). One of the 1992 definitions of current smoking (smoking every day or some days) was identical to the definition used in 1993; these estimates are compared in this report. In 1993, an estimated 46 million (25.0% [95% CI= plus or minus 0.7%]) adults in the United States were current smokers (Table 1): 20.4% (95% CI= plus or minus 0.7%) were daily smokers, and 4.6% (95% CI= plus or minus 0.3%) were some-day smokers. Smoking prevalence was significantly higher among men (27.7% [95% CI= plus or minus 1.1%] [24 million men]) than among women (22.5% [95% CI= plus or minus 0.9%] [22 million women]) (Table 1). The racial/ethnic group-specific prevalence was highest among American Indians/Alaskan Natives (38.7% [95% CI= plus or minus 8.7%]) and lowest among Asians/Pacific Islanders (18.2% [95% CI= plus or minus 4.1%]). The prevalence of smoking among persons with less than or equal to 8 years of education was significantly lower than that among persons with 9-15 years of education; however, among persons with greater than or equal to 9 years of education, prevalences varied inversely with education level. For all groups, the prevalence of smoking was highest among males who had dropped out of high school (42.1% [95% CI= plus or minus 4.4%]). Smoking prevalence was higher among persons living below the poverty level* (32.1% [95% CI= plus or minus 2.4%]) than among those living at or above the poverty level (23.8% [95% CI= plus or minus 0.8%]). The prevalence of current smokers in 1993 was unchanged statistically from 1992 (25.0% and 26.3%, respectively). However, the prevalence of daily smoking in 1993 (20.4% [95% CI= plus or minus 0.7%]) was significantly lower than in 1992 (22.3% [95% CI= plus or minus 0.9%]). In addition, prevalence estimates for current smokers during 1993 were lower overall for women, persons with a college education or higher, total persons living at or above the poverty level, and women living at or above the poverty level (Table 1). Of current smokers, an estimated 32 million persons (69.7% [95% CI= plus or minus 1.6%]) reported they wanted to quit smoking completely. Women were more likely to report an interest in quitting (72.7% [95% CI= plus or minus 1.9%]) than men (67.1% [95% CI= plus or minus 2.2%]). Current smokers aged greater than or equal to 65 years (49.9% [95% CI=5.8%]) were the least likely to report that they wanted to completely stop smoking. In 1993, an estimated 46 million adults were former smokers (49.6% [95% CI= plus or minus 1.2%] of ever smokers) (Table 2). The prevalence of cessation was higher among men (51.9% [95% CI= plus or minus 1.5%]), whites (51.6% [95% CI= plus or minus 1.3%]), and persons living at or above the poverty level (52.4% [95% CI= plus or minus 1.2%]), and increased directly with age. Among education levels, the prevalence of cessation was lowest among persons with 9-11 years of education (38.2% [95% CI= plus or minus 3.3%]). Reported by: Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial Note: Although the overall prevalence of current smoking did not change from 1992 to 1993, the prevalence of daily smoking declined during 1993, possibly reflecting the proliferation of restrictive worksite and public smoking policies (4). In addition, the relatively greater decline among women is consistent with a previous report that, in workplace settings, women may be more likely to quit smoking because of worksite smoking bans (5). Differences in prevalence among racial/ethnic groups may be influenced by differences in education levels and socioeconomic status, as well as by social and cultural phenomena. For example, in a recent report (6), the prevalence of behavioral risk factors, including cigarette smoking, was generally higher among persons with less than or equal to 12 years of education. From 1992 to 1993, daily smoking prevalence increased among high school seniors from 17.2% to 19.0% (1). To be effective, school-based prevention programs should begin in kindergarten and continue through high school. This intervention should be especially intensive in middle school and should be reinforced in high school. CDC has published guidelines for incorporating tobacco-use prevention and cessation strategies in the early grades in schools (7). School-based programs should provide instruction about the short- and long-term physiologic and social consequences of tobacco use, social influences on tobacco use, peer norms regarding tobacco use, and refusal skills. The findings in this report are subject to at least two limitations. First, because the 1992 and 1993 estimates are based on data collected during a 6-month period, these estimates may not be representative of annual prevalence. In particular, other data suggest that the restriction of the surveys to these periods may have minimized the true magnitude of declines in prevalence (National Household Survey on Drug Abuse, unpublished data, 1992 and 1993). Second, because these estimates are based on self-reported data, prevalences may be underestimated. However, underreporting is believed to be low in national prevalence surveys (8). To sustain the decline in smoking prevalence, efforts must be intensified to discourage initiation and to promote cessation. Although 70% of smokers want to stop smoking and 34% attempt to quit each year, only 2.5% successfully stop smoking each year (9). The high rate of relapse is a consequence of the effect of nicotine dependence. Smokers who need assistance with stopping can receive self-help materials from local voluntary agencies, CDC (telephone [800] 232-1311 or [404] 488-5705), and the National Institutes of Health (telephone [800] 422-6237). Many smokers are addicted to nicotine and could potentially benefit from nicotine replacement therapy (NRT); NRT and other cessation assistance can be obtained from physicians and dentists. Information about formal cessation programs can be obtained from local voluntary agencies or health-care providers. The health risks of cigarette smoking can be eliminated only by quitting; switching to lower "tar" and nicotine cigarettes is not a safe alternative (10). Comprehensive measures for promoting cessation and reducing the prevalence of smoking include increasing tobacco excise taxes, enforcing minors' access laws, restricting smoking in public places, restricting tobacco advertising and promotion, and conducting counter-advertising campaigns. References 1. Giovino GA, Schooley MW, Zhu B-P, et al. Surveillance for selected tobacco-use behaviors--United States, 1900-1994. MMWR 1994;43(no. SS- 3). 2. CDC. Cigarette smoking among adults--United States, 1992, and changes in the definition of current cigarette smoking. MMWR 1994;43:342-6. 3. Shah BV. Software for Survey Data Analysis (SUDAAN), version 5.50 [Software documentation]. Research Triangle Park, North Carolina: Research Triangle Institute, 1991. 4. Evans NJ, Gilpin E, Pierce JP, et al. Occasional smoking among adults: evidence from the California Tobacco Survey. Tobacco Control 1992;1:169-75. 5. Brenner H, Mielck A. Smoking prohibition in the workplace and smoking cessation in the Federal Republic of Germany. Prev Med 1992;21:252-61. 6. CDC. Prevalence of selected risk factors for chronic disease by education level in racial/ethnic populations--United States, 1991- 1992. MMWR 1994;43:894-9. 7. CDC. Guidelines for school health programs to prevent tobacco use and addiction. MMWR 1994;43(no. RR-2). 8. CDC. The health benefits of smoking cessation: a report of the Surgeon General, 1990. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1990; DHHS publication no. (CDC)90- 8416. 9. CDC. Smoking cessation during previous year among adults--United States, 1990 and 1991. MMWR 1993;42:504-7. 10. US Department of Health and Human Services. The health consequences of smoking: the changing cigarette--a report of the Surgeon General, 1981. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1981; DHHS publication no. (PHS)81-50156. *Poverty statistics are based on a definition 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: Wed, 18 Jan 95 06:51:49 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR] Abortion Surveillance - Preliminary Data Message-ID: <31m5yc2w165w@stat.com> Abortion Surveillance: Preliminary Data -- United States, 1992 For 1992, CDC received data about legal induced abortions from 52 reporting areas (the 50 states, New York City, and the District of Columbia). This report presents preliminary data for 1992. In 1992, a total of 1,359,145 legal abortions were reported to CDC (Table 1), a decrease of 2.1% from the number reported for 1991 (1), and the number of live births decreased by 1.1% (2). As a result, the national abortion ratio (number of legal abortions per 1000 live births) decreased from 339 in 1991 to 335 in 1992 (Figure 1). The national abortion rate (number of legal abortions per 1000 women aged 15-44 years) also declined from 24 in 1991 to 23 in 1992. This rate increased each year from 1972 to 1980 (when it peaked [25]); since 1980, the rate has remained stable, fluctuating from 23 to 24. As in previous years, approximately 92% of women who had a legal abortion were residents of the state in which the procedure was performed. Women who obtained legal abortions in 1992 were predominately aged less than 25 years, white, and unmarried. Compared with 1991, a lower proportion of women who had abortions in 1992 had had live-born children (48% and 46%, respectively). Curettage (suction and sharp) remained the primary abortion procedure (approximately 99% of all such procedures). As in previous years, approximately half of legal abortions were performed during the first 8 weeks of gestation (Table 1): 14% of abortions were performed at less than or equal to 6 weeks, 15% at 7 weeks, and 21% at 8 weeks' gestation. As in previous years, approximately 89% of abortions were performed during the first 12 weeks of pregnancy. Reported by: Statistics and Computer Resources Br, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial Note: The annual number of abortions in the United States has remained relatively stable since 1980, varying each year by less than or equal to 5%. However, since 1990 (the year in which the number of abortions was highest), the number of abortions has decreased each year. In 1992, the national ratio of abortions to live births was lower than for any year since 1977, indicating that a greater proportion of pregnancies ended in a live birth (3). The national fertility rate (number of live births per 1000 women of reproductive age [15-44 years]) also peaked in 1990 and has declined somewhat since then (2). As in previous years, most women who obtained an abortion were white. However, the abortion rate for black women is approximately three times that for white women (CDC, unpublished data, 1991). Differences in abortion by race may reflect differences in socioeconomic status, education level, contraceptive use, and access to family planning, contraceptive, and abortion services. Although the total number of legal induced abortions during 1992 was available for all 52 reporting areas, approximately 26% of the abortions were reported from states that do not have centralized reporting; these areas could not provide information on the characteristics of women obtaining abortions. Interpretation of temporal comparisons is constrained because the number of states that report characteristics varies each year. Many states emphasize the prevention of unintended pregnancy, particularly among teenagers. Abortion and birth statistics both are essential to provide estimates of pregnancy rates. To assist efforts to prevent unintended pregnancy, an accurate assessment of abortion (including the number and characteristics of women obtaining legal abortions in all states) is needed on an ongoing basis. In 1992, most areas reported abortions at less than or equal to 8 weeks of gestation by week of gestation for the first time. This approach to reporting will assist in monitoring trends in legal abortions. Additional statistical and epidemiologic information about legal induced abortions is available from CDC's automated Reproductive Health Information line at (404) 330-1230, which provides information by fax, voice recordings, or mail. References 1. CDC. Abortion surveillance: preliminary data--United States, 1991. MMWR 1994;43:42-4. 2. NCHS. Advance report of final natality statistics, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Monthly vital statistics report; vol 43, no. 5, suppl). 3. CDC. Abortion surveillance, 1977. Atlanta: US Department of Health and Human Services, Public Health Service, 1979. ------------------------------ Date: Wed, 18 Jan 95 06:52:43 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR] Trends Among Women Who Did Not Receive Prenatal Care Message-ID: State-Specific Trends Among Women Who Did Not Receive Prenatal Care - - United States, 1980-1992 Lack of prenatal care is strongly associated with an increased risk úÿ for low birthweight (less than 2500 g [less than 5 lbs 8 oz] at birth) infants, preterm delivery, and maternal and infant mortality (1). From 1980 through 1992, the nationally aggregated percentage of pregnant women who did not receive prenatal care increased by 31%--from 1.3% to 1.7% (2,3). Because nationally aggregated data can obscure variations among states, CDC analyzed state-specific data derived from birth certificates for 1980- 1992 to examine trends among women who did not receive prenatal care. This report summarizes the findings of the analysis. Prenatal-care data were ascertained from the section on the birth certificate indicating the month of pregnancy in which prenatal care was initiated. State-specific percentages for each year from 1980 through 1992 were ordered from lowest to highest to determine the 25th, 50th (i.e., median), and 75th percentiles and maximum value for each year. In addition, state-specific percentages for women who did not receive prenatal care were compared for 1980-1981 and 1991-1992 using the total number of births to women who did not receive prenatal care and the total number of births. Absolute change was calculated by comparing the percentages for 1980- 1981 with those for 1991-1992. From 1980 to 1989, the median state-specific percentage of births to women who did not receive prenatal care increased from 0.8% to 1.3% (Figure 1). Although patterns for the 25th and 75th percentiles were similar, the maximum value increased substantially--from 3.7% in 1980 to 7.5% in 1989; in 1992, the percentage declined to 4.8%. Percentages were consistently high in the District of Columbia, Florida, New Mexico, New York, and Texas. For 1980-1981, the percentage of women who did not receive prenatal care ranged from 0.14% (Vermont) to 3.67% (New York) (Table 1); for 1991- 1992, the percentages ranged from 0.32% (Utah) to 5.63% (District of Columbia). When compared with 1980-1981, during 1991-1992 the percentage of women who did not receive prenatal care declined in eight states (Florida, Kentucky, New Jersey, New York, Oklahoma, Rhode Island, South Dakota, and Utah) and increased in 42 states and the District of Columbia; in nine states, the increase was greater than 100% (Delaware, Illinois, Indiana, Louisiana, Michigan, Ohio, Pennsylvania, Vermont, and Wisconsin). Reported by: Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Health and Utilization Analysis, National Center for Health Statistics, CDC. Editorial Note: Federal and state initiatives during the mid-1980s aimed to increase access to prenatal care by expanding Medicaid eligibility and increasing funding for maternal and child health block grants and other state-funded programs (4,5). The decrease in the percentage of births to women who did not receive prenatal care during 1991-1992 is the most substantial decrease recorded since 1969 (the first year data about prenatal-care initiation were reported). Despite these improvements, approximately 69,000 women did not receive prenatal care in 1992. Health agencies commonly use aggregated data to describe national patterns in prenatal care in the United States. However, the findings in this and other reports indicate the importance of using state-specific data to fully elucidate and better understand long-term trends (6). In particular, these findings documented substantial variation among states for the percentage of women who did not receive prenatal care. For example, the comparison of data for 1980-1981 with 1991-1992 demonstrated slight decreases in the percentage of women who did not receive prenatal care in eight states and substantial increases in nine others. The findings in this report are subject to at least two limitations. First, the overall increase in the percentage of women who did not receive prenatal care may have been related to improved case ascertainment. From 1980 to 1992, the percentage of women for whom initiation of prenatal care was unknown decreased from 2.8% in 1980 to 2.2% in 1992. However, the increase in the percentage of women who did not receive prenatal care may have been related to the decrease in the percentage of women who initiated prenatal care during the second trimester (from 18.1% in 1980 to 16.7% in 1992). The percentages of women who initiated prenatal care during the first or third trimester remained unchanged (74% and 4%, respectively). Second, estimates of the prevalence of nonreceipt of prenatal care may be inaccurate because a standard method of measuring initiation of prenatal care is not available. Although maternal postpartum interview data (7) and birth certificate data identify similar percentages of women who do not receive prenatal care, these sources may not identify the same women. For example, in a national sample of women who gave birth in 1988, among those who were identified either by the birth certificate or maternal interview as not receiving prenatal care, only 33% were identified by both sources (7). Because the importance of prenatal care is widely accepted and efforts are made to provide such care to all women, nonreceipt of prenatal care should be considered a sentinel health event. A sample of these episodes should be investigated to identify and implement interventions. In particular, public health workers need to determine the reasons for nonreceipt of prenatal care (e.g., choosing not to obtain care, inability to pay for care, or lack of providers or transportation), and state health departments should consider the financial, programmatic, and social factors that are associated with nonreceipt of prenatal care. References 1. Office of Technology Assessment, US Congress. Healthy children: investing in the future. Washington, DC: US Congress, Office of Technology Assessment, 1988. 2. NCHS. Vital statistics of the United States, 1980. Vol I, natality. Washington, DC: US Department of Health and Human Services, Public Health Service, 1984; DHHS publication no. (PHS)85-1100. 3. Ventura SJ, Martin JA, Taffel SM, et al. Advance report of final natality statistics, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Monthly vital statistics report; vol 43, no. 5, suppl). 4. Singh S, Forrest JD, Torres A. Prenatal care in the United States: a state and county inventory. Vols 1 and 2. New York: Alan Guttmacher Institute, 1989. 5. Committee to Study Outreach for Prenatal Care, National Institute of Medicine. Prenatal care: reaching mothers, reaching infants. Washington, DC: National Academy Press, 1988. 6. Ingram DD, Makuc D, Kleinman JC. National and state trends in use of prenatal care, 1970-83. Am J Public Health 1986;76:415-23. 7. Schoendorf KC, Parker JD, Batkhan LZ, Kiely JL. Comparability of the birth certificate and 1988 Maternal and Infant Health Survey. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1993; DHHS publication no. (PHS)93-1390. (Vital and health statistics; series 2, no. 116). ------------------------------ Date: Wed, 18 Jan 95 06:53:37 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: [MMWR] Bolivian Hemorrhagic Fever Message-ID: <34m5yc4w165w@stat.com> Bolivian Hemorrhagic Fever -- El Beni Department, Bolivia, 1994 In July 1994, an outbreak of Bolivian hemorrhagic fever (BHF), which is caused by Machupo virus, began in northeastern Bolivia. This report describes the investigation and features of this outbreak, the search for additional cases of BHF in El Beni, Bolivia, and results of rodent investigations. Initial Investigation The outbreak initially occurred among members of an extended family residing in Magdalena (1994 population: approximately 5300) located in the north central Province of Itenez, El Beni Department (Figure 1). From July 4 through August 12, 1994, seven family members (aged 10 months-50 years) developed an illness characterized by fever, hypotension, subconjunctival and gingival bleeding, epistaxis, petechiae, tremor, and dysarthria. Six of these persons died; the person who had the index case survived. Laboratory studies performed on serum and tissue specimens from decedents confirmed the diagnosis of BHF by isolation of Machupo virus and detection of viral antigen in all five patients for whom specimens were available; the survivor developed enzyme-linked immunosorbent assay (ELISA) immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies to Machupo virus. Search for Other Cases Following identification of the familial cluster, three additional persons in Bolivia with suspected BHF were reported to the National Secretary of Health through provincial health departments. On August 18, a broken test tube in a centrifuge exposed a 37-year-old laboratory technician in Santa Cruz to aerosolized blood from one of the family members who died. On August 29, the technician developed an acute febrile illness with lower back pain, arthralgias, and mild conjunctivitis. On August 30, intravenous therapy with the antiviral compound ribavirin was initiated for a presumptive diagnosis of BHF. She had no hemorrhagic manifestations and recovered from her illness. Machupo antigen detection and virus isolation studies on serum obtained before initiation of ribavirin treatment were negative, as were IgG and IgM antibody ELISAs on serum specimens collected 3 months after onset. On August 28, a 41-year-old man residing in Magdalena (with no known link to any infected persons) developed an illness that included fever, chills, and hip pain. On September 2, he was transferred to a hospital in Cochabamba, Bolivia, and died on September 5 following a fulminant hemorrhagic clinical course. Machupo virus was isolated and viral antigen was detected in the patient's serum. On September 3, a 52-year-old agricultural worker from Poponas, El Beni Department, developed a febrile hemorrhagic illness; on September 11, he was admitted to a hospital in Trinidad, El Beni Department. On September 13, intravenous ribavirin therapy was initiated for a presumptive diagnosis of BHF, and the patient recovered. The diagnosis of BHF was confirmed by detection of viral antigen and virus isolation from the patient's serum. Family members of these three persons with presumptive or confirmed BHF cases and health-care workers in contact with these persons were monitored for febrile illness. However, illness was not noted in these patient contacts. Rodent Investigation During August and September 1994, rodent trapping was conducted in areas of potential exposure for the affected family. During 1811 trap-nights,* 84 rodents were captured, including nine Calomys callosus. Testing for antibodies to Machupo virus was negative for each of the 84 rodents. Virus isolation studies on captured rodents are pending. Reported by: M Villagra, MD, National Hemorrhagic Fever Program, National Secretary of Health, Ministry of Human Development; L Suarez, MD, Regional Health Secretary, El Beni Department; R Arce, MD, Magdalena Hospital, Magdalena, Province of Itenez, El Beni Department, Bolivia. MG Moreira, MD, Pan American Health Organization, La Paz, Bolivia. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC. Editorial Note: BHF is a viral hemorrhagic fever known to be endemic only in Bolivia; first described in 1959, it caused outbreaks in small communities in eastern Bolivia throughout the 1960s (1). The etiologic agent, Machupo virus, is a member of the family Arenaviridae and is maintained in the rodent C. callosus, the natural reservoir (2). As with other arenaviruses, infection of the rodent host results in a persistent asymptomatic infection with shedding of virus in urine. Human infections are believed to occur following exposure to the virus in aerosolized rodent urine. A nosocomial outbreak of BHF in Cochabamba in 1971 suggested that person-to-person transmission also may occur by airborne or parenteral routes (3). Following an incubation period of 1-2 weeks, patients infected with Machupo virus may develop an influenza-like illness with fever, malaise, and fatigue followed by the onset of headache, dizziness, myalgias, and severe lower back pain. Prostration, abdominal pain, anorexia, tremors, and hemodynamic instability may be followed by hemorrhagic manifestations, including bleeding from the oral and nasal mucosa and the gastrointestinal, genitourinary, and bronchopulmonary tracts (4). BHF can be diagnosed by virus isolation from acute serum or tissue specimens or by virus antigen detection using an ELISA. Antibodies can be detected using plaque- reduction neutralization, indirect immunofluorescence, or ELISAs. Because of the risk for laboratory-acquired infections with this highly lethal agent, tests with potentially infectious material should be performed in a biosafety level 4 laboratory (5). Treatment of BHF employs supportive measures. Although uncontrolled trials have used convalescent immune plasma from survivors of BHF, evaluation of the effectiveness of this therapy has been limited by the lack of plasmapheresis capability and availability of qualified donors. Ribavirin, a broad-spectrum antiviral agent, has been effective against human Lassa fever and several arenavirus diseases in animal models. Patients infected with Junin virus, a closely related arenavirus, also have received the drug (6), but there is no definitive evidence concerning efficacy. From 1959 through 1962, Bolivian health officials reported 470 cases of BHF with 142 deaths (case-fatality rate: 30%) (7). Until the cases described in this report, the last confirmed outbreak in Bolivia occurred in 1971 (3). The mode of transmission of BHF in the familial outbreak described in this report is unclear. Although no C. callosus were captured in the town of Magdalena, a low density of C. callosus was noted in rural areas around Magdalena where the index case had worked and traveled. Previous trapping in Bolivia has shown fluctuations in population numbers and prevalence of infection among C. callosus, but the determining factors are not known (2,8). Previous cases of BHF occurred following rodent invasion of households in towns and exposure during campestral activities, including sleeping in primitive shelters (9). Infection with Machupo virus among travelers returning to the United States has not been recognized. References 1. Mackenzie RB, Beye HK, Valverde L, Garron H. Epidemic hemorrhagic fever in Bolivia. Am J Trop Med Hyg 1964;13:620-5. 2. Johnson KM, Kuns ML, Mackenzie RB, Webb PA, Yunker CE. Isolation of Machupo virus from wild rodent Calomys callosus. Am J Trop Med Hyg 1966;15:103-6. 3. Peters CJ, Kuehne RW, Mercado RR, Le Bow RH, Spertzel RO, Webb PA. Hemorrhagic fever in Cochabamba, Bolivia, 1971. Am J Epidemiol 1974;99:425- 33. 4. Peters CJ. Arenaviruses. In: Belshe RB, ed. Textbook of human virology. Littleton, Massachusetts: PSG Publishing Company, Inc, 1984:513-45. 5. CDC. Biosafety in microbiological and biomedical laboratories. 3rd ed. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1993:135-7; DHHS publication no. (CDC)93-8395. 6. Enria DA, Maiztegui JI. Antiviral treatment of Argentine hemorrhagic fever. Antiviral Res 1994;23:23-31. 7. Hemorrhagic Fever Commission of Bolivia. Hemorrhagic fever in Bolivia [Spanish]. Bulletin of the Panamerican Health Office 1965;58:93-104. 8. Mercado R. Rodent control programmes in areas affected by Bolivian hemorrhagic fever. Bull World Health Organ 1975;52:691-6. 9. Stinebaugh BJ, Schloeder FX, Johnson KM, Mackenzie RB, Entwisle G, DeAlba E. Bolivian hemorrhagic fever. Am J Med 1966;40:217-29. * The total number of traps set in 1 night multiplied by the total number of nights during which traps were set. ------------------------------ Date: Wed, 18 Jan 95 06:54:40 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: CancerNet Update for January, 1995 Message-ID: +----------------------------------------------+ | NATIONAL INSTITUTE | | C A N C E R | | INTERNATIONAL INFORMATION | | C E N T E R | +----------------------------------------------+ | CancerNet@icicb.nci.nih.gov | +-------------------------------+ CancerNet is now available on the FEDWORLD BBS. You can access FEDWORLD via dial-up ( 703 321-8020 8N1) or via the Internet (telnet to: fedworld.gov ( 192.239.93.3) login: new ). Select Option D (Health Mall) on the Main menu and Option B (National Cancer Institute - CancerNet(NCI)). Changes to CancerNet, January 1995 CancerNet was updated on January 3, 1995. PDQ Statements -------------- The following PDQ statements were added or updated in CancerNet with the January update (see the file Monthly PDQ Changes -- cn-405001 for detailed information on the changes in each statement). New Statements: The following treatment statements for physicians were added: Breast Cancer and Pregnancy cn- 105380 Primary Central Nervous System Lymphoma cn- 104272 The following prevention statements were added: Prevention of Cervical Cancer cn- 304734 Prevention of Ovarian Cancer cn- 305375 Changed Statements: Changed treatment statements for physicians: Adult Brain Cancer cn- 101143 Adult Non-Hodgkin's Lymphoma cn- 100066 Breast Cancer cn- 100013 Childhood Non-Hodgkin's Lymphoma cn- 100915 Changed treatment statements for patients: Adult Non-Hodgkin's Lymphoma cn- 200066 Prostate Cancer cn- 201229 Changed supportive care statements: None. Changed screening/prevention statements: None. Changed drug information statements: None. Changed other PDQ information: None. Changed CancerNet News and NCI Publication Information: ------------------------------------------------------- The following news bulletin was added: Scientific Committee Makes Recommendation for FTC's Cigarette Test cn-400076 The following news bulletins were changed: Group C Protocol Information cn-400014 FDA's Mammography Quality Standards Act Takes Effect cn-400075 The following news bulletin was deleted: Availability of Erwinia L-Asparaginase cn-400056 There were no changes to the NCI publications. NCI Fact Sheets --------------- The following fact sheets were changed: Waldenstrom's Macroglobulinemia cn- 600064 Financial Assistance for Cancer Care cn- 600083 Referral Information for the BCPT complete list cn- 400021 BCPT Referral (partial list - Hawaii to Michigan cn- 400023 BCPT Referral (partial list - North Dakota to Texas cn- 400025 Referral Information for the PCPT (complete list) cn- 400090 PCPT Referral (partial list) - Alabama to Georgia cn- 400091 PCPT Referral (partial list) - Illinois to Michigan cn- 400092 PCPT Referral (partial list) - Minnesota to North Carolina cn- 400093 CANCERLIT Citations and Abstracts: ---------------------------------- No new CANCERLIT citation and abstract topics were added. The CANCERLIT citations and abstracts for January will be available on úÿ on January 6, 1994. Replace the __ with the two digit month code when requesting CANCERLIT citation and abstract topics from the CancerNet mail server. 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Although both the English and Spanish are updated at the same time each month, the Spanish statements do not reflect the changes made in the English statements until the following month to allow time for translation . If you are interested in requesting CancerNet statements or news articles in Spanish, it is suggested that you request an updated Contents List. If you are redistributing the PDQ information you retrieve from CancerNet to others at your location, or are interested in redistributing the information from CancerNet, request the news article, Redistribution of Cancernet (cn-400030) , to find out about conditions that apply when redistributing the information. This article also has information on other sites providing access to CancerNet information. Please send comments or questions to: Cheryl Burg NCI International Cancer Information Center Internet: cheryl@icicb.nci.nih.gov ------------------------------ Date: Wed, 18 Jan 95 06:55:38 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: Q&A About AIDS Saliva Test Message-ID: Centers for Disease Control and Prevention National Center for Infectious Diseases Division of HIV/AIDS Atlanta, GA December 1994 Questions and Answers about the Saliva HIV Antibody Test 1Q. What is this new test using saliva? 1A. The Food and Drug Administration (FDA) has approved a device to collect oral fluid for use with a laboratory test to detect antibody to HIV. This assay uses a special collection device to obtain a specimen of saliva which is then tested for HIV antibody. The device resembles an ordinary cotton swab in appearance. No needles or skin puncturing are required. 2Q. Is this test as good as the blood tests that have been in use for years? 2A. Since confirmatory tests are not yet licensed for saliva, any individual whose saliva tests reactive will still have to have their blood drawn for follow-up testing. Positive results will continue to require blood testing for HIV antibody. CDC studies show that the sensitivity of a correctly used saliva HIV antibody test is acceptable for use in public health and clinical settings where follow up serologic testing is in place. 3Q. If you can do an HIV antibody test on saliva, then why isn't HIV transmitted by kissing? 3A. This test detects HIV antibody which is a protein present in saliva, even when HIV itself is not present in saliva. Previous studies have shown that low levels of HIV can be found in saliva especially when visible blood is present. Although studies have not shown HIV transmission via contact with saliva, the Public Health Service advises against deep kissing with known infected persons because of a theoretical risk of transmission. 4Q. Who will be able to use this test? 4A. The device will be sold to physicians who may train non- medical persons to collect clinical specimens to evaluate patients who consent to it. Specimens must be processed in a laboratory as blood specimens currently are. This is not a "home test kit." 5Q. How should this test be used? 5A. Persons who are tested for HIV antibody with this saliva test should be given the same considerations as with any HIV test. They should consent to be tested and receive appropriate pre and post test counseling. All test results should be kept confidential. 6Q. What counseling message should be provided to clients that have a reactive HIV-1 saliva test? 6A. Clients who wish to be tested with the saliva HIV-1 test should be counseled during the informed consent session about the meanings of any possible reactive results. Risk behavior assessment and discussion about change in any risky behaviors are critical parts of the counseling process. Persons who receive a reactive saliva result should abstain from sex (or use condoms if unable to abstain) and needle use and not donate blood or tissue until results have been confirmed with the use of routine HIV antibody blood tests, e.g., ELISA and Western blot. Follow-up counseling should include the elements of appropriate medical and psychosocial referrals. 7Q. How much will a test cost? Will it be less than a blood test? 7A. Prices will be set by the test kit's manufacturer, the laboratory that performs the test, and the clinician who collects the specimen or orders the test. As with other medical tests, prices are likely to vary widely. ------------------------------ Date: Wed, 18 Jan 95 06:57:02 MST From: mednews@stat.com (HICNet Medical News) To: hicnews Subject: Clinical Alert - Ischemic Optic Neuropathy Decompression Trial Findings Message-ID: Clinical Alert: National Eye Institute Announces Ischemic Optic Neuropathy Decompression Trial (IONDT) Findings. Abstract: The IONDT compared the safety and efficacy of optic nerve decompression surgery plus careful followup versus careful followup alone in patients with non-arteric ischemic optic neuropathy (NAION). Preliminary results indicate that decompression surgery was no better than careful followup, based on a detailed statistical analysis. It is concluded that optic nerve decompression surgery is not an appropriate treatment for NAION. The following is the text of a letter, dated January 3, 1995, sent to ophthalmologists and neurologists, and signed by Dr. Carl Kupfer, Dr. Shalom Kelman, and Dr. Kay Dickersin. Dear Colleague: This letter is to inform you of findings from the Ischemic Optic Neuropathy Decompression Trial (IONDT) that warrant your attention prior to publication of the results. This randomized, controlled clinical trial is supported by the National Eye Institute (NEI), part of the National Institutes of Health, and is being conducted at 25 clinical centers nationwide (see attached list of study sites). The study is headquartered at the University of Maryland at Baltimore. The IONDT compared the safety and efficacy of optic nerve decompression surgery plus careful followup versus careful followup alone in patients with non-arteritic ischemic optic neuropathy (NAION). All patients were diagnosed with NAION by IONDT neuro- ophthalmologists. In the study, decompression surgery was standardized, and each physician's surgical ability was reviewed by the IONDT's Surgical Quality Assurance Committee. Moreover, all surgeons were required to have previously performed ten or more decompression operations to be certified to participate in the study. As of September, 1994, the study had received and analyzed outcome data from 244 patients. Of these patients, 119 had been randomized to decompression surgery and 125 to careful followup, with 95 and 91, respectively, having completed six months of followup. Preliminary results indicate that decompression surgery was no better than careful followup, based on a detailed statistical analysis. These results include: o At six months of followup, 43 percent of careful followup patients improved three or more lines of vision (using the New York Lighthouse chart). In the surgery group, 33 percent had a three-line improvement in their vision over the same followup period. Thus, surgery has no positive effect on outcome compared to careful followup. o Twelve percent of eyes in careful followup lost three or more lines of vision at six months, compared to 24 percent in the surgical group. This suggests that decompression surgery may be harmful. o The IONDT's finding that 43 percent of careful followup patients had spontaneous improvement of three or more lines in their vision (See Bullet 1) is much higher than previously reported. Most of the earlier studies had indicated a spontaneous improvement rate of ten percent or less. o No beneficial surgical effect on visual acuity was seen in patients with progressive visual loss. In late October 1994, the IONDT's Data and Safety Monitoring Committee reviewed these preliminary findings and recommended that recruitment to the IONDT cease with enrolled patients continuing to be followed. Thereafter, the NEI halted patient recruitment, and study investigators reviewed the data. A scientific paper was submitted to the Journal of the American Medical Association for expedited review in mid-November, was accepted, and will be published in an upcoming issue of the Journal. Based on the above results, we conclude that optic nerve decompression surgery is not an appropriate treatment for NAION. We can offer no recommendation regarding the safety and efficacy of this surgery for other conditions. Sincerely, Carl Kupfer, M.D. Director National Eye Institute Shalom Kelman, M.D. IONDT Chairman University of Maryland at Baltimore School of Medicine Kay Dickersin, Ph.D. Director, IONDT Coordinating Center University of Maryland at Baltimore School of Medicine ISCHEMIC OPTIC NEUROPATHY DECOMPRESSION TRIAL Participants List California Steven Feldon, M.D. Doheny Eye Institute University of Southern California 1450 San Pablo Street Los Angeles, California 90033- 4683 Telephone: (213) 342-6488 Anthony Arnold, M.D. Jules Stein Eye Institute 100 Stein Plaza, UCLA Los Angeles, California 90024-7005 Telephone: (310) 825-4344 Jonathan Horton, M.D. Department of Ophthalmology University of California, San Francisco Eight Kirkham Street San Francisco, California 94143-0644 Telephone: (415) 476-7176 Florida John R. Guy, M.D. Department of Ophthalmology University of Florida Box 100-284, JHMHC Gainesville, Florida 32610-0284 Telephone: (904) 392-3451 Georgia Nancy J. Newman, M.D. Emory Eye Center Emory University 1327 Clifton Road, N.E. Atlanta, Georgia 30322 Telephone: (404) 248-5358 Illinois James A. Goodwin, M.D. Department of Ophthalmology University of Illinois 1855 West Taylor Street Chicago, Illinois 60612 Telephone: (312) 996-9120 Kentucky Robert S. Baker, M.D. Department of Ophthalmology University of Kentucky Room E304 Kentucky Clinic 801 Rose Street Lexington, Kentucky 40536-0284 Telephone: (606) 323-5875 Maryland Shalom E. Kelman, M.D. Professional Building University of Maryland 419 West Redwood Street Suite 420 Baltimore, Maryland 21201 Telephone: (410) 328-3858 Michigan Wayne Cornblath, M.D. W. K. Kellogg Eye Center University of Michigan 1000 Wall Street Ann Arbor, Michigan 48105 Telephone: (313) 936-9503 Barry Skarf, M.D. Henry Ford Hospital Department of Ophthalmology K-10 2799 West Grand Boulevard Detroit, Michigan 48202 Telephone: (313) 876-3243 David I. Kaufman, D.O. Department of Ophthalmology Michigan State University Unit for Neuro-visual Disorders A217 Clinical Center 138 Service Road East Lansing, Michigan 48824 Telephone: (517) 432-4923 Edward Cohn, M.D. William Beaumont Eye Institute William Beaumont Hospital 3535 West Thirteen Mile Suite 506 Royal Oak, Michigan 48073 Telephone: (810) 551-8282 Minnesota Brian R. Younge, M.D. Mayo Clinic, E-7A Mayo Building 200 First Street, S.W. Rochester, Minnesota 55905 Telephone: (507) 284-5833 Missouri Lenworth Johnson, M.D. Mason Eye Institute University of Missouri - Columbia One Hospital Drive Columbia, Missouri 65212 Telephone: (314) 882-5935 Sophia M. Chung, M.D. Anheuser-Busch Eye Institute 1755 South Grand Boulevard St. Louis, Missouri 63104 Telephone: (314) 865-8323 New York Deborah Friedman, M.D. SUNY Health Science Center 750 East Adams Street Syracuse, New York 13210 Telephone: (315) 464-5253 North Carolina Mark Malton, M.D. Carolinas Medical Center 2015 Randolph Road, Suite 108 úÿ (continued next message) ÿ@FROM :david@STAT.COM úÿ(Continued from last message) Charlotte, North Carolina 28207 Telephone: (704) 334-2020 Ohio Gregory Kosmorsky, D.O. The Cleveland Clinic Foundation Desk A 31/Ophthalmology 9500 Euclid Avenue Cleveland, Ohio 44195 Telephone: (216) 444-2855 Pennsylvania John Kennerdell, M.D. Allegheny General Hospital 420 East North Avenue, Suite 116 Pittsburgh, Pennsylvania 15212 Telephone: (412) 359-6300 South Carolina Mitchell J. Wolin, M.D. University of South Carolina Department of Ophthalmology #4 Richland Medical Park, Suite 100 Columbia, South Carolina 29203 Telephone: (803) 224-6375 Texas Rosa A. Tang, M.D. University of Texas 2476 Bolsover, #359 Houston, Texas 77005 Telephone: (713) 668-6828, Utah Kathleen A. Digre, M.D. University of Utah Department of Ophthalmology 50 North Medical Drive Salt Lake City, Utah 84132 Telephone: (801) 581-7614 Virginia Steven A. Newman, M.D. University of Virginia Department of Ophthalmology Box 475 Charlottesville, Virginia 22908 Telephone: (804) 924-5978 Warren L. Felton III, M.D. Department of Neurology Division of Neuro-ophthalmology Medical College of Virginia Box 980599 Richmond, Virginia 23298-0599 Telephone: (804) 828-4806 West Virginia John Linberg, M.D. West Virginia University Department of Ophthalmology P.O. Box 9193 Morgantown, West Virginia 26506 Telephone: (304) 293-3757 RESOURCE CENTERS Chairman's Office Shalom E. Kelman, M.D. Professional Building University of Maryland 419 West Redwood Street Suite 460 Baltimore, Maryland 21201 Telephone: (410) 328-3858 Coordinating Center Kay Dickersin, Ph.D. Department of Epidemiology & Preventive Medicine University of Maryland 228 Howard Hall 660 West Redwood Street Baltimore, Maryland 21201 Telephone: (410) 328-8159 ------------------------------ End of HICNet Medical News Digest V08 Issue #03 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD