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
(June 4, 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 DIABETES MELLITUS --
UNITED STATES, 1980-1989
Problem/Condition: In 1989, approximately 6.7 million persons
reported that they had diabetes, and a similar number probably had
this disabling chronic disease without being aware of it. Diabetes
mellitus is the most important cause of lower extremity amputation
and end-stage renal disease, the major cause of blindness among
working-age adults, a major cause of disability, premature
mortality, congenital malformations, perinatal mortality, and
health-care costs, and an important risk factor for the development
of many other acute and chronic conditions (e.g., diabetic
ketoacidosis, ischemic heart disease, and stroke). Surveillance
data describing diabetes and its complications are critical to
increasing recognition of the public health burden of diabetes,
formulating health-care policy, identifying high-risk groups,
developing strategies to reduce the burden of this disease, and
evaluating progress in disease prevention and control.
Reporting Period Covered: This report summarizes data from CDC's
diabetes surveillance system, evaluating trends in diabetes and its
complications by age, sex, and race for the years 1980-1989 (end
year depending on data source).
Description of System: CDC has established an ongoing and evolving
surveillance system to analyze and compile periodic, representative
data on the disease burden of diabetes and its complications in the
United States. Data sources currently include vital statistics, the
National Health Interview Survey, the National Hospital Discharge
Survey, and Medicare claims data for end-stage renal disease.
Results and Interpretation: These surveillance data indicate that
the disease burden of diabetes and its complications is likely to
grow as the population ages, that effective intervention strategies
are needed to prevent diabetes and its complications, that
prevention efforts need to be intensified among groups at highest
risk, including blacks, and that important gaps exist in periodic
and representative data for describing the burden of diabetes and
its complications.
Actions Taken: CDC is currently exploring possible data sources to
address the surveillance data gaps on blindness, adverse outcomes
of pregnancy, and the public health burden of diabetes among
minority groups.
Authors: Linda S. Geiss, M.A., William H. Herman, M.D., Merilyn G.
Goldschmid, M.D., Frank DeStefano, M.D., M.P.H., Division of
Diabetes Translation, National Center for Chronic Disease
Prevention and Health Promotion, CDC. Mark S. Eberhardt, Ph.D.,
Office of Analysis and Epidemiology, National Center for Health
Statistics, CDC. Earl S. Ford, M.D., M.P.H., Robert R. German,
M.P.H., Jeffrey M. Newman, M.D., M.P.H., David R. Olson, Ph.D.,
Stephen J. Sepe, M.P.H., John M. Stevenson, Ph.D., Frank Vinicor,
M.D., M.P.H., Scott F. Wetterhall, M.D., M.P.H., Julie C. Will,
Ph.D., Division of Diabetes Translation, National Center for
Chronic Disease Prevention and Health Promotion, CDC.
LABORATORY-BASED SURVEILLANCE FOR MENINGOCOCCAL DISEASE
IN SELECTED COUNTIES -- UNITED STATES, 1989-1991
Problem/Condition: Neisseria meningitidis is a leading cause of
bacterial meningitis and septicemia in the United States. Accurate
surveillance for meningococcal disease is required to detect trends
in patient characteristics, antibiotic resistance, and
serogroup-specific incidence of disease.
Reporting Period Covered: January 1989 through December 1991.
Description of System: A case of meningococcal disease was defined
by the isolation of Neisseria meningitidis from a normally sterile
site, such as blood or cerebrospinal fluid, in a resident of a
surveillance area. Cases were reported by contacts in each hospital
laboratory in the surveillance areas. The surveillance areas
consisted of three counties in the San Francisco metropolitan area,
eight counties in the Atlanta metropolitan area, four counties in
Tennessee, and the entire state of Oklahoma.
Results: Age- and race-adjusted projections of the U.S. population
suggest that approximately 2600 cases of meningococcal disease
occurred annually in the United States. The case-fatality rate was
12%. Incidence declined from 1.3 per 100,000 in 1989 to 0.9 per
100,000 in 1991. Seasonal variation occurred, with the highest
attack rates in February and March and the lowest in September. The
highest rates of disease were among infants, with 46% of cases in
those less than or equal to 2 years of age. Males accounted for 55%
of total cases, with an incidence among males of 1.2 per 100,000,
compared with 1.0 per 100,000 among females (relative risk
{RR}=1.3, 95% confidence interval {CI}=1.0-1.6). The incidence was
significantly higher among blacks (1.5 per 100,000) than whites
(1.1 per 100,000), with a relative risk of disease for blacks of
1.4 (95% CI=1.1-1.8). Serogroup B caused 46% of cases and serogroup
C, 45%. Thirty-eight percent of isolates were reported to be
resistant to sulfa; none were reported to be resistant to rifampin.
Interpretation: The decline in incidence of meningococcal disease
from 1989 to 1991 cannot be explained by any change in public
health control measures; this trend should be monitored by
continued surveillance. The age, sex, and race distribution and
seasonality of cases are consistent with previous reports. The
proportion of N. meningitidis isolates resistant to sulfa continues
to be substantial. A relatively small proportion of cases is
potentially preventable by the use of the currently available
polysaccharide vaccine, which induces protection against serogroups
A, C, Y, and W135 and is effective only for persons greater than 2
years of age.
Actions Taken: Current recommendations against the use of sulfa
drugs for treatment or prophylaxis of meningococcal disease unless
the organism is known to be sulfa sensitive should be continued.
Since resistance to rifampin is rarely reported, it continues to be
the drug of choice for prophylaxis. The development of vaccines
effective for infants and vaccines inducing protection against
serogroup B would be expected to have a substantial impact on
disease.
Authors: Lisa A. Jackson, M.D., Jay D. Wenger, M.D., Meningitis and
Special Pathogens Branch, Division of Bacterial and Mycotic
Diseases, National Center for Infectious Diseases, CDC. The
Meningococcal Disease Study Group.
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