MMWR supplements最新文献

Problem/condition: Hazardous chemicals are transported and used widely in the United States, and acute chemical releases (lasting <72 hours) are not uncommon. Characterizing acute incidents within geographic areas can help researchers identify spatial patterns and differences and enable public and environmental health and safety practitioners, members of local emergency planning committees, preparedness coordinators, industry managers, emergency responders, and others to prepare for and respond to chemical incidents.

Reporting period: 1999-2008.

Description of system: The Hazardous Substances Emergency Events Surveillance (HSEES) system was operated by the Agency for Toxic Substances and Disease Registry (ATSDR) during January 1991-September 2009 to collect data on hazardous chemical releases that would enable researchers to describe the public health consequences of these acute releases and to develop activities aimed at reducing the ensuing harm to the public. This report summarizes data for the geographic distribution of reported acute incidents by states, counties, and Metropolitan Statistical Areas (MSAs) from the nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 full years of data collection (1999-2008).

Results: A total of 57,975 acute incidents occurred during 1999-2008; five MSAs accounted for 40.1% of all incidents. Texas reported 41% of all incidents reported by the nine states during the 10-year study period, and Colorado reported the fewest incidents (3.4%).

Interpretation: Storage, use, and transport of hazardous substances often are associated with unanticipated releases. In general, releases occurred more frequently in areas that use or store more hazardous chemicals and in urbanized areas compared with rural areas. In rural areas, most incidents were related to the transport of hazardous chemicals. The primary economic activities in an area had a strong influence on the frequency and type of chemicals released in the area. PUBLIC HEALTH IMPLICATIONS: Exposure to hazardous chemicals can have immediate and serious health consequences. Harmful releases can occur wherever hazardous chemicals are used, stored, or transported. The time and location of releases is unpredictable. Taken together, these elements underscore the need for preparedness. A culture of safety, prevention, and preparedness can minimize the consequences of future incidents.

Problem/condition: Acute chemical incidents (i.e., uncontrolled or illegal release or threatened release of hazardous substances lasting <72 hours) represent a substantial threat to the environment, public health and safety, and community well-being. Providing a timely and appropriate public health response can prevent or reduce the impact of these incidents.

Reporting period: 1999-2008.

Description of system: The Hazardous Substances Emergency Events Surveillance (HSEES) system was operated by the Agency for Toxic Substances and Disease Registry (ATSDR) during January 1991-September 2009 to describe the public health consequences of chemical releases and to develop activities aimed at reducing the harm. This report summarizes types, frequency, and trends in public health actions taken in response to hazardous substance incidents in the nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 full years of data collection (1999-2008).

Results: Of the 57,975 HSEES incidents that occurred during 1999-2008, a total of 15,203 (26.2%) incidents resulted in at least one public health action taken to protect public health. Evacuations were ordered in 4,281 (7.4%) HSEES incidents, shelter in place was ordered in 509 (0.9%) incidents, and access to the affected area was restricted in 10,345 (25.9%) incidents. Decontamination occurred in 2,171 (3.7%) incidents; 13,461 persons were decontaminated, including 1,152 injured persons. Actions to protect public health (e.g., environmental sampling or issuance of health advisories) were taken in 6,693 (11.5%) incidents. The highest number of evacuations and orders to shelter in place occurred in Washington (n = 558 [16.1%] and n = 121 [3.2%], respectively). Carbon monoxide and ammonia releases resulted in the highest percentage of orders to evacuate and shelter in place. The most frequently reported responders to chemical incidents were company response teams.

Interpretation: The most frequent public health response was restricting access to the area (26% of incidents), public health actions (12%), evacuation (7%), decontamination (4%), and shelter-in-place (1%). Ammonia and carbon monoxide were associated with adverse health effects in the population and the most public health response actions. Therefore, these chemicals can be considered a high priority for prevention and response efforts. PUBLIC HEALTH IMPLICATIONS: States and communities can collaborate with facilities to use the information collected through community right-to-know legislation and this report to improve chemical safety and protect public health and the environment, such as being prepared to handle the most common chemicals in their area and probable public health actions.

Problem/condition: Although they are infrequent, acute chemical incidents (i.e., uncontrolled or illegal release or threatened release of hazardous substances lasting <72 hours) with mass casualties or extraordinary levels of damage or disruption severely affecting the population, infrastructure, environment, and economy occur, and thousands of less damaging chemical incidents occur annually. Surveillance data enable public health and safety professionals to better understand the patterns and causes of these incidents, which can improve prevention efforts and preparation for future incidents.

Reporting period: 1999-2008.

Description of system: The Hazardous Substances Emergency Events Surveillance (HSEES) system was operated by the Agency for Toxic Substances and Disease Registry (ATSDR) during January 1991-September 2009 to describe the public health consequences of chemical releases and to develop activities aimed at reducing the harm. This report provides a historical overview of HSEES and summarizes incidents from the nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 full years of data collection (1999-2008).

Results: During 1999-2008, a total of 57,975 chemical incidents occurred: 41,993 (72%) occurred at fixed facilities, and 15,981 (28%) were transportation related. Chemical manufacturing (NAICS 325) (23%) was the industry with the most incidents; however, the number of chemical incidents in chemical manufacturing decreased substantially over time (R² = 0.78), whereas the educational services category (R² = 0.65) and crop production category (R² = 0.61) had a consistently increasing trend. The most common contributing factors for an incident were equipment failure (n = 22,535, 48% of incidents) and human error (n = 16,534, 36%). The most frequently released chemical was ammonia 3,366 (6%). Almost 60% of all incidents occurred in two states, Texas and New York. A decreasing trend occurred in the number of incidents in Texas, Wisconsin, and Colorado, and an increasing trend occurred in Minnesota.

Interpretation: Although chemical manufacturing accounted for the largest percentage of incidents in HSEES, the number of chemical incidents over time decreased substantially for this industry while heightened awareness and prevention measures were being implemented. However, incidents in educational services and crop production settings increased. Trends in incidents and number of incidents varied by state. Only a certain few chemicals, sectors, and areas were found to be related to the majority of incidents and injured persons. Equipment failure and human error, both common casual factors, are preventable. PUBLIC HEALTH IMPLICATIONS: The findings in this collection of surveillance summaries underscore the need for educational instituti

This MMWR Supplement presents data related to disease patterns across the United States and describes recent national trends in health status. Indicators of health status (i.e., measures of observed or calculated data on the status of a health condition) were chosen to reflect the range of health issues relevant to CDC's programs that are used across the agency to monitor health. In response to the status of these health issues, CDC works with state and local health systems across the United States on these diseases and others to save lives and protect persons.

Problem: Although substantial progress has been made in improving the health of persons in the United States, serious problems remain to be solved. Life expectancy is increasing, and the rates of the leading causes of death are improving in many cases; however, numerous indicators (i.e., measures of observed or calculated data on the status of a condition) of the health and safety of the U.S. population remain poor. This report reviews population health in the United States and provides an assessment of recent progress in meeting high-priority health objectives. The health status indicators described in this report were selected because of their direct relation to the leading causes of death and other substantial sources of morbidity and mortality and should be the focus of prevention efforts.

Reporting period covered: Data are reported starting in 2005 (or the earliest available year since 2005) through the current data year. Because data sources and specific indicators vary regarding when data are available, the most recent year for which data are available might range from 2010 to 2013.

Description of the system: Data were obtained from 17 CDC surveys or surveillance systems and three non-CDC sources to provide a view of this particular point of time in the nation's health and trends in recent years. Data from the following CDC surveillance systems and surveys were used: Behavioral Risk Factor Surveillance System (BRFSS); Emerging Infections Program/Active Bacterial Core surveillance (EIP/ABCs); Foodborne Diseases Active Surveillance Network (FoodNet); Internet Panel Surveys: Influenza Vaccination Coverage Among Health-Care Personnel and Influenza Vaccination Coverage Among Pregnant Women; National Ambulatory Medical Care Survey (NAMCS); National Health and Nutrition Examination Survey (NHANES); National Health Interview Survey (NHIS); National Healthcare Safety Network (NHSN); National HIV Surveillance System; National Hospital Discharge Survey (NHDS); National Immunization Survey (NIS); National Immunization Survey-Teen (NIS-Teen); National Notifiable Disease Surveillance System (NNDSS); Nationally Notifiable STD Surveillance; National Vital Statistics System (NVSS); and Youth Risk Behavior Surveillance System (YRBSS). Three non-CDC sources were used: the Alcohol and Tobacco Tax and Trade Bureau Monthly Statistical Releases; the National Highway Traffic Safety Administration Fatality Analysis Reporting System (FARS); and the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (NSDUH).

Results: Since 2005, life expectancy at birth in the U.S. has increased by 1 year; however, the number of persons who died prematurely was relatively constant. The years of potential life lost declined for eight of the 10 leading causes of death. Age-adjusted rates declined among all leading causes except deaths attributable to

The first cases of the current West African epidemic of Ebola virus disease (hereafter referred to as Ebola) were reported on March 22, 2014, with a report of 49 cases in Guinea. By August 31, 2014, a total of 3,685 probable, confirmed, and suspected cases in West Africa had been reported. To aid in planning for additional disease-control efforts, CDC constructed a modeling tool called EbolaResponse to provide estimates of the potential number of future cases. If trends continue without scale-up of effective interventions, by September 30, 2014, Sierra Leone and Liberia will have a total of approximately 8,000 Ebola cases. A potential underreporting correction factor of 2.5 also was calculated. Using this correction factor, the model estimates that approximately 21,000 total cases will have occurred in Liberia and Sierra Leone by September 30, 2014. Reported cases in Liberia are doubling every 15-20 days, and those in Sierra Leone are doubling every 30-40 days. The EbolaResponse modeling tool also was used to estimate how control and prevention interventions can slow and eventually stop the epidemic. In a hypothetical scenario, the epidemic begins to decrease and eventually end if approximately 70% of persons with Ebola are in medical care facilities or Ebola treatment units (ETUs) or, when these settings are at capacity, in a non-ETU setting such that there is a reduced risk for disease transmission (including safe burial when needed). In another hypothetical scenario, every 30-day delay in increasing the percentage of patients in ETUs to 70% was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic (however, the epidemic still eventually ends). Officials have developed a plan to rapidly increase ETU capacities and also are developing innovative methods that can be quickly scaled up to isolate patients in non-ETU settings in a way that can help disrupt Ebola transmission in communities. The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely.

This supplement is the second of a series of periodic reports from a CDC initiative to monitor and report on the use of a set of selected clinical preventive services in the U.S. population in the context of recent national initiatives to improve access to and use of such services. Increasing the use of these services can result in substantial reductions in the burden of illness, death, and disability and lower treatment costs. This supplement focuses on services to improve the health of U.S. infants, children, and adolescents. The majority of clinical preventive services for infants, children, and adolescents are provided by the health-care sector. Public health agencies play important roles in increasing the use of these services by identifying and implementing policies that are effective in increasing use of the services and by collaborating with stakeholders to conduct programs to improve use. Recent health-reform initiatives, including efforts to increase the accessibility and affordability of preventive services, fund community prevention programs, and improve the use of health information technologies, offer opportunities to improve use of preventive services. This supplement, which follows a previous report on adult services, provides baseline information on the use of a set of selected clinical preventive services to improve the health of infants, children, and adolescents before implementation of these recent initiatives and discusses opportunities to increase the use of such services. This information can help public health practitioners, in collaboration with other stakeholders that have key roles in improving infant, child, and adolescent health (e.g., parents or guardians and their employers, health plans, health professionals, schools, child care facilities, community groups, and voluntary associations), understand the potential benefits of the recommended services, address the problem of underuse, and identify opportunities to apply effective strategies to improve use and foster accountability among stakeholders.