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Significant Public Health Events of 1980
The purpose of the Morbidity and Mortality Weekly Report (MMWR) is to alert the public health community of events that affect the health and well-being of populations not only in the United States but worldwide as well. In the United States, for 1980 the 4 infectious diseases most frequently reported to the MMWR were the same as they had been for the recent past-gonorrhea, chickenpox, syphilis, and hepatitis. Some infectious diseases reached record levels in their reported occurrence. Measles, mumps, and rubella reached their lowest reported occurrence since they became nationally notifiable, in a large part due to the effects of the Childhood Immunization Initiative and to the efforts of the Measles Elimination Program which has as its goal the elimination of indigenous measles by October 1982. Other infectious diseases such as leprosy and Rocky Mountain spotted fever reached their highest reported occurrence. Some of the major items covered in the 1980 issues of the MMWR were toxic-shock syndrome (TSS), the increase in certain drug-resistant micro-organisms, a new rabies vaccine, the public health effects of the eruption of Mount St. Helens, an increase in heat-stroke deaths caused by the heat wave of 1980, and the influx of refugees with their unique health problems.
The event to which the news media gave a great deal of coverage in 1980 was the study of TSS that revealed a statistical association between this syndrome and tampon use in menstruating women. This study-performed in collaboration with State health departments-demonstrated a greater risk with one specific brand of tampon that prompted the manufacturer to withdraw its product from the market on September 22. Although the etiologic agent for TSS has not been definitely established, several independent studies suggest a role for selected strains of Staphylococcus
A need for a more potent biologic led to the development of a new rabies vaccine. On June 8, 1980, the Food and Drug Administration licensed for use in the United States the new human diploid cell vaccine (HDCV) for rabies which caused the recommendations of the Immunization Practices Advisory Committee to be revised to reflect the availability of this vaccine. HDCV is now the vaccine of choice because it is a more immunogenic vaccine and the frequency of severe reactions following its administration is lower than that for duck-embryo vaccine.
The detection of additional drug-resistant micro-organisms was an event of worldwide significance that resulted from intensive surveillance and investigation. Drugresistant cholera in Bangladesh, gonorrhea in the United States, malaria acquired in Thailand, and tuberculosis in the United States were all reported for 1980. Consequently, clinical practices had to be altered and surveillance for the effect of these changes enhanced.
Two natural disasters occurred in 1980 that had significant effects on public health. On May 18, the Mount St. Helens volcano erupted, prompting the initiation of several epidemiologic studies and the establishment of surveillance activities. To date, the measurable public health impact of the eruption has been the detection of associated respiratory illnesses among those exposed to high concentrations of ash. The National Institute of Occupational Safety and Health played a critical role in determining the composition of the volcanic ash and initiated a long-term study of possible health effects to loggers who continue to be exposed to the ash. The Centers for Disease Control (CDC) also played an important role in the federal health response by coordinating the publication of 23 issues of the Mount St. Helens Health Bulletin. A second natural disaster that had public health ramifications and that also occurred in 1980, began the last week of June and continued through the first 3 weeks of July. It was a severe heat wave combined with drought-like conditions that affected many midwestern and southern states. Because high rates of heat-wave related mortality were observed in several states, CDC was asked to do studies of heat-related morbidity and mortality. The results from these studies helped to define the risk factors for development of severe heat illness and to identify persons at high risk. One of the important findings was the confirmation that poverty is a significant risk factor in heat-wave-related morbidity and mortality.
Man-made disasters also contributed to the significant events of 1980. Because of these disasters and for humanitarian reasons, thousands of refugees were resettled in the United States, making health screening in the resettlement camps and at the ports of entry into the United States a major task. The identification of cases of malaria and tuberculosis, some of which were attributed to drug-resistant organisms, among these refugees was one of the reasons for the reported increased occurrence of these diseases for 1980. However, no major public health problems resulted from this large influx of refugees.
History of Morbidity Reporting and Surveillance
in the United States
In 1978 an Act of Congress authorized collection of morbidity reports by the Public Health Service to establish quarantine measures for diseases such as cholera, smallpox, plague, and yellow fever. In 1893 another Act authorized the collection of information on a weekly basis from state and municipal authorities throughout the United States, and gradually an increasing number of states submitted monthly and annual summaries to the Public Health Service. It was not until 1925, however, that all states began to report regularly.
Responsibilities for data collection and analysis were subsequently transferred several times within the Public Health Service. The Communicable Disease Center acquired responsibility for the venereal disease program in 1957, the tuberculosis program in 1960, the collection of data on nationally notifiable diseases in 1961, and the foreign quarantine program in 1967. The changing characteristics of diseases have necessitated modifications in the reporting system and the addition of new diseases.
In 1970 the Communicable Disease Center was renamed the Center for Disease Control to reflect a broader mandate in preventive health services. Over the years the surveillance systems maintained by CDC have expanded, and emphasis has shifted as certain diseases have lower incidence rates and other diseases have taken on new aspects. In addition, CDC's increasing interest in noncommunicable diseases is reflected in new programs in family planning, childhood lead poisoning prevention, congenital birth defects, and chronic diseases.
In 1978 the Consolidated Surveillance and Communications Activity (CSCA) was established in the Bureau of Epidemiology to provide ongoing examination of surveillance efforts, including MMWR statistics. This activity's primary responsibility is to work with state health departments and bureaus within CDC to propose, coordinate, and evaluate future changes in surveillance activities.
In 1981, CDC was officially reorganized and renamed the Centers for Disease Control. In the reorganization, CSCA and the responsibility for publishing the MMWR were transferred to the newly created Epidemiology Program Office.