Publication of CDC Surveillance Summaries

Since 1983, CDC has published the CDC Surveillance Summaries under separate cover as part of the MMWR series. Each report published in the CDC Surveillance Summaries focuses on public health surveillance; surveillance findings are reported for a broad range of risk factors and health conditions.

Summaries for each of the reports published in the most recent (March 19, 1993) issue of the CDC Surveillance Summaries (1) are provided below. All subscribers to MMWR receive the CDC Surveillance Summaries, as well as the MMWR Recommendations and Reports, as part of their subscriptions.

SURVEILLANCE FOR AND COMPARISON OF BIRTH DEFECT PREVALENCES IN TWO GEOGRAPHIC AREAS -- UNITED STATES, 1983-88

Problem/Condition: CDC and some states have developed surveillance systems to monitor the birth prevalence of major defects.

Reporting Period Covered: This report covers birth defects surveillance in metropolitan Atlanta, Georgia, and selected jurisdictions in California for the years 1983-1988.

Description of System: The California Birth Defects Monitoring Program and the metropolitan Atlanta Congenital Defects Program are two population-based surveillance systems that employ similar data collection methods. The prevalence estimates for 44 diagnostic categories were based on data for 1983-1988 for 639,837 births in California and 152,970 births in metropolitan Atlanta. The prevalences in the two areas were compared, adjusting for race, sex, and maternal age by using Poisson regression.

Results: Regional differences in the prevalence of aortic stenosis, fetal alcohol syndrome, hip dislocation/dysplasia, microcephalus, obstruction of the kidney/ureter, and scoliosis/lordosis may be attributable to general diagnostic variability. However, differences in the prevalences of arm/hand limb reduction, encephalocele, spina bifida, or trisomy 21 (Down syndrome) are probably not attributable to differences in ascertainment, because these defects are relatively easy to diagnose.

Interpretation: Regional differences in prenatal diagnosis and pregnancy termination may affect prevalences of trisomy 21 and spina bifida. However, the reason for differences in arm/hand reduction is unknown, but may be related to variability in environmental exposure, heterogeneity in the gene pool, or random variation.

Actions Taken: Because of the similarities of these data bases, several collaborative studies are being implemented. In particular, the differences in the birth prevalence of spina bifida and Down syndrome will focus attention on the impact of prenatal diagnosis. Authors: Jane Schulman, Ph.D., Nancy Jensvold, M.P.H, Gary M. Shaw, Dr.P.H., California Birth Defects Monitoring Program, March of Dimes Birth Defects Foundation. Larry D. Edmonds, M.S.P.H., Anne B. McClearn, Division of Birth Defects and Developmental Disabilities, National Center for Environmental Health, CDC.

INFLUENZA -- UNITED STATES, 1988-89

Problem/Condition: CDC monitors the emergence and spread of new influenza virus variants and the impact of influenza on morbidity and mortality annually from October through May.

Reporting Period Covered: This report covers U.S. influenza surveillance conducted from October 1988 through May 1989.

Description of System: Weekly reports from the vital statistics offices of 121 cities provided an index of influenza's impact on mortality; 58 WHO collaborating laboratories reported weekly identification of influenza viruses; weekly morbidity reports were received both from the state and territorial epidemiologists and from 153 sentinel family practice physicians. Nonsystematic reports of outbreaks and unusual illnesses were received throughout the year.

Results: During the 1988-89 influenza season, influenza A(H1N1) and B viruses were identified in the United States with essentially equal frequency overall, although both regional and temporal patterns of predominance shifted over the course of the season. Throughout the season increases in the indices of influenza morbidity in regions where influenza A(H1N1) predominated were similar to increases in regions where influenza B predominated. Only 7% of identified viruses were influenza A(H3N2), but isolations of this subtype increased as the season waned, and it subsequently predominated during the 1989-90 season. During the 1988-89 season outbreaks in nursing homes were reported in association with influenza B and A(H3N2) but not influenza A(H1N1).

Interpretation: The alternating temporal and geographic predominance of influenza strains A(H1N1) and B during the 1988-89 season emphasizes the importance of continual attention to regional viral strain surveillance, since amantadine is effective only for treatment and prophylaxis of influenza A.

Actions Taken: Weekly interim analyses of surveillance data produced throughout the season allow physicians and public health officials to make informed choices regarding appropriate use of amantadine. CDC's annual surveillance allows the observed viral variants to be assessed as candidates for inclusion as components in vaccines used in subsequent influenza seasons. Authors: Louisa E. Chapman, M.D., M.S.P.H., Epidemiology Activity, Office of the Director, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Margaret A. Tipple, M.D., Division of Quarantine, National Center for Prevention Services, CDC. Suzanne Gaventa Folger, M.P.H., Health Investigations Branch, Division of Health Studies, Agency for Toxic Substances and Disease Registry. Maurice Harmon, Ph.D., Connaught Laboratories, Pasteur- Mirieux Company, Swiftwater, Pennsylvania. Alan P. Kendal, Ph.D., European Regional Office, World Health Organization, Copenhagen, Denmark. Nancy J. Cox, Ph.D., Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Lawrence B. Schonberger, M.D., M.P.H., Epidemiology Activity, Office of the Director, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC.

Reference

1. CDC. CDC surveillance summaries (March 19). MMWR 1993;42(no. SS-1).

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