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HEAT-RELATED ILLNESS Deaths in St. Louis, Missouri, residents, by day,

June and July, 1978, 1979, and 1980

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During the summer of 1980, record-breaking high temperatures occurred in much of the United States, especially in southern and midwestern states. Nationwide, estimates of the number of deaths due to the heat have ranged from 1,265 to as high as 1,800.

The cities of St. Louis and Kansas City, Missouri, were particularly severely affected. A total of 279 deaths attributed by physicians to the heat were counted in these 2 cities alone. Another 505 persons survived heat-related illness severe enough to require hospitalization.

Epidemiologic investigation undertaken in the 2 cities included a review of the demographic characteristics of 208 heatstroke cases and case-control study of 156 of these cases. Heatstroke rates for persons 65 years or older were 12 to 13 times the rates for the remainder of the population. Low socioeconomic status and race other-than-white were characteristics also associated with increased rates of heatstroke. Biologic or medical conditions which were associated with heatstroke included inability to care for oneself, alcoholism, and the use of certain antipsychotic drugs (phenothiazines, butyrophenones, and thioxanthenes). Heatstroke tended to occur among residents of homes that lacked air conditioning or were surrounded by only a sparse growth of trees and shrubbery and among residents of the higher floors of multistory buildings. Reducing activity, spending more time in air-conditioned places (independent of whether or not there was a home air conditioner), and taking extra liquids appeared to be effective preventive measures.

LEAD POISONING

LEAD POISONING – Number of children screened in childhood lead-based paint

poisoning prevention projects by quarter, 1977-1980

140

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In 1980, 63 programs reported screening 512,504 children. Of those screened, 25,293 (4.9%) were identified as having lead toxicity. The definition of lead toxicity is a blood lead >30 mg/dl with an erythrocyte protoporphyrin (EP) >50 ug/dl. All children ages 1-5 should be screened at least annually. Although the screening rate for this age group has increased, this rate in 1980 was only 3,275/100,000 which was significantly below the desired level. The rate of lead toxicity among or in the screened population was 4,935/100,000. Using the estimated population of ages 1-5 in the United States, the prevalence of lead toxicity is 162/100,000. This clearly underestimates the extent of the problem, since screening data are only reported from 63 communities in the United States.

The seasonal fluctuation shown in screening and lead toxicity is probably due to the intensive screening efforts by all programs during warmer weather. The EP test also identifies children with iron deficiency. During 1980, 20,063 children (3.9% of children screened) were identified as iron deficient.

Although lead is a pervasive contaminant in the environment, epidemiologic investigations indicate that lead-based paint remains the most common high-dose lead source for children with lead toxicity.

LEAD POISONING - Number of children screened and found to have lead toxicity in childhood

lead-based paint poisoning prevention programs, United States, 1972-1980

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LEAD POISONING

Results of screening in childhood lead-based paint poisoning control projects,

United States, October 1979 - September 1980

[graphic]

United States

502,925 26,519 17,441

9,078

21,074 HHS REGIONI

46,795 2,370

1,460
910

1,285 Bridgeport, Conn.

4,005
130
71

59 Waterbury, Conn.

2,607
103
70
33

219 Portland, Maine?

160
24

8
16

0 Boston, Mass.

19,268

935
510
425

617 Chelsea, Mass.?

55
0
0
0

3 Lawrence, Mass

7,019

578
451
127

168 Worcester, Mass.

6,447

228
173
55

155 Rhode Island State

7,234
372
177
195

75 HHS REGION II

163,007 9,498

6,475
3,023

9,288 Atlantic City, N.J.

1,619

95
45
50

30 Camden, N.J.

2,673

196
138
58

68 East Orange, N.J.

2,484

272
196
76

452 Jersey City, N.J.

3,136

428
306
122

119 Long Branch, N.J.

1,087

64
49
15

65 Newark, NJ.

6,729 1,134

790
344

277 Paterson, N.J.

4,428

375
275
100

347 Plainfield, N.J.

2,477

192
132
60

167 N.J. (Other local progs.)?

2,637
473
261
212

150 Erie Co., NY

6,840

310
230
80

48 Monroe Co., NÀY.

5,570

462
346
116

274 New York City

111,188
5,108 3,422 1,686

6,757 Onondaga Co., N.Y.

7,513

227
165
62

236 Westchester Co., NY

4,626

162
120
42

298 HHS REGION II

79,268 5,505 3,676

1,829

3,426 Delaware State

4,504

213
141
72

255 Washington, D.C.

15,810

387
266
121

1,515 Baltimore, Md.

12,345

155
96
59

340 Allentown-Bethelem, Pa.

2,891

40
29
11

364 Chester, Pa.

2,739

81
56
25

47 Philadelphia, Pa.

21,768 4,183 2,763

1,420

238 Wilkes-Barre, Pa.

2,883

84
66
18

98 York, Pa.

1,401
35

11

128 Lynchburg, Va.

2,062

34
28
6

97 Norfolk, Va

4,592
113
81
32

72 Portsmouth, Va.

2,234

70
50
20

141 Richmond, Va.

6,039
110
76
34

131 HHS REGION IV

28,461

658
431
227

789 Augusta, Ga.

2,986

48
38
10

113 Louisville, Ky

10,468

303
201
102

417 Cabarrus Co., N.C.

171

2
0
2

0 S.C. State

7,444

213
128
85

183 Memphis, Tenn.

7,392

92
64
28

76 HHS REGION V

116,897 5,798 3,832

1,966

3,799 Chicago, III.

43,220 3,123

2,014
1.109

101 Kankakee, III.

1,941

36
29
7

82 Madison Co., III.

2,306
30

12 Rockford, III.

256 2,704

43
30
13

96 Waukegan-Lake Co., III.

2,287

30
15

121 III. (Other local progs.)?

4,444

165
108
57

16 Ft. Wayne-Allen Co., Ind.

1,679

46
29
17

3 Detroit, Mich.

19,199

712
479
233

151 Grand Rapids, Mich.

3,961

50
32
18

49 Wayne Co., Mich.

1,682

79
33
46

91 Akron, Ohio

5,237

247
206
41

547 Cincinnati, Ohio

9,185

279
194
85

1,366 Cleveland, Ohio

13,005

589
399
190

793 Beloit, Wis.

1,090

32
22
10

34 Milwaukee, Wis.

4,957

322
209
113

93 HHS REGION VI

33,111

729
476

253 Arkansas State

1,022 10,930

239
143

96 Louisiana State

240 3,233

25
5

o New Orleans, La.

11,365

356
237

119 Houston, Tex.

7,583
104
71
33

364 HHS REGION VII

24,369 1,885

1,056
829

701 Cedar Rapids-Linn Co., lowa

4,029

70
40
30

89 Davenport-Scott Co., lowa

2,705

60
44
16

70 St. Louis, Mo.

13,258 1,603

859
744

245 Springfield, Mo.?

1,267

65
52
13

220 Omaha-Douglas Co., Neb.

3,110

87
61
26

77 HHS REGION IX

11,017

76
35
41

764 Alameda Co., Calif.

3,063

41
24
17

82 Los Angeles, Calif.

7,954

35
11
24

682 Screening Class II and Classes III & IV defined in CDC Statement, "Preventing Lead Poisoning in Young children," April 1978.

Reporting program not receiving lead poisoning prevention grant support as of end of fiscal year. 'Estimated.

PNEUMONIA-INFLUENZA – Observed and expected ratio of deaths attributed to pneumonia and influenza

in 121 U.S. cities, as determined by the time series method, September 1979-August 1981

PNEUMONIA-INFLUENZA

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*FORECASTS ARE MADE AT 4-WEEK INTERVALS EXCEPT DURING EPIDEMIC PERIODS

Every four weeks throughout the year the expected ratio of pneumonia and influenza (P&I) deaths to total deaths from all causes-in the absence of influenza epidemics-is forecast by the time series analysis of past nonepidemic mortality data to monitor mortality attributed to influenza activity. Large increases beyond the expected ratio of P&l deaths are usually associated with influenza A epidemics. This surveillance method is based on data from 121 urban centers, most of whose populations exceed 100,000 and whose total populations constitute approximately 26% of the U.S. population. These ratios represent not only an index of the national mortality attributable to P&I, but provide a readily available indicator of any increases associated with influenza. The following pages depict the total national mortality attributable to P&l based on final mortality data reported by the National Center for Health Statistics, with expected numbers being generated using time series analysis.

The predominant influenza viruses causing illness in the United States during 198081 were influenza A (H3N2) strains, generally closely related to A/Bangkok/1/79. Although influenza A (H1N1) and influenza B were isolated from several states, few outbreaks were reported to have been caused by influenza A (H1N1), and no outbreaks were reported for influenza B. Morbidity reports of influenza-like illness were received from schools, nursing homes, and industries. Reported deaths from 121 cities were elevated for a 13-week period beginning December 13, 1980.

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