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recommendations for use of antiviral medications have a changed, enhanced surveillance for detection of oseltamivir. resistant influenza viruses is ongoing and will enable continued monitoring of changing trends over time. In addition to vaccination and antivirals, other means of decreasing ta spread and impact of influenza include staying home free work or school when ill, avoiding others who are sick, corering the nose or mouth with a tissue when coughing a sneezing, and frequent hand washing. Additional information is available at habits.htm.

Influenza surveillance reports for the United States ar posted online weekly during October-May and are avail. able at Additional information regarding influenza viruses, inf: enza surveillance, the influenza vaccine, and avian intlıenza is available at

Influenza A (H1N1) viruses predominated through midJanuary, but influenza A (H3N2) viruses were more frequently identified than influenza A (H1N1) viruses since late January and have predominated overall. The majority of influenza A (H1N1) viruses were characterized as A/Solomon Islands/3/2006, the influenza A (H1N1) component of the 2007–08 influenza vaccine for the Northern Hemisphere. To date, the majority of influenza A (H3N2) and influenza B viruses were characterized as A/Brisbanel 10/2007 and B/Florida/04/2006, respectively, the recommended influenza A (H3N2) and influenza B components of the 2008-09 influenza vaccine for the Northern Hemisphere.

Clinical vaccine effectiveness cannot be accurately predicted using these data. A case-control study to estimate the effectiveness of trivalent inactivated influenza vaccine was conducted this season in Marshfield, Wisconsin. Preliminary results from subjects enrolled during January 21February 8 show an overall vaccine effectiveness of 44%, suggesting that vaccination provided substantial protection against influenza-associated, medically attended illness in the study population, despite the suboptimal vaccine match (3). These preliminary results are similar to previous studies, which have shown that influenza vaccination provides measurable protection against influenza illness and influenza-related complications and death, even when vaccine strains are antigenically distinct from circulating strains (4-7).

As a supplement to influenza vaccination, antiviral drugs have aided in the control and prevention of influenza. Recent studies have identified a considerable protective effect of oseltamivir treatment against complications associated with influenza (8), including death among older adults hospitalized with laboratory-confirmed influenza (9). This season, resistance to the influenza antiviral drug oseltamivir among influenza A (H1N1) viruses (84 (10.2%] of 824 tested) has been detected. All 84 resistant influenza A (H1N1) viruses identified in the United States this season share the same genetic mutation; this mutation is the most common mutation in this subtype that confers resistance to oseltamivir. Increased resistance to oseltamivir among influenza A (H1N1) viruses has been reported from many countries this season (10). No oseltamivir resistance has been detected among influenza A (H3N2) or B viruses currently circulating in the United States. Given the low level of resistance to oseltamivir, the finding of resistance only in some influenza A (H1N1) viruses, and no resistance to zanamivir, these drugs continue to be recommended for the treatment and prophylaxis of influenza (2). Although

Acknowledgments This report is based on data contributed by participating state ar. territorial health departments and state public health laboratories, Wor Health Organization collaborating laboratories, National Respirates and Enteric Virus Surveillance System collaborating laboratories, t. U.S. Influenza Sentinel Provider Surveillance System, the US Department of Veterans Affairs/U.S. Department of Defense Bio Sena Outpatient Surveillance System, the New Vaccine Surveillance Na work, the Emerging Infections Program, and the 122 Cities Mortali Reporting System. References 1. CDC. Update: influenza activity–United States, September 3!

February 9, 2008. MMWR 2008;57:179–83. 2. CDC. Health Advisory: influenza antiviral use for persons at high to

for influenza complications or who have severe influenza illness. Atlana GA: US Department of Health and Human Services, CDC; 2012 Available at

alertnum=00271. 3. CDC. Interim within-season estimate of the effectiveness of trivac

inactivated influenza vaccine-Marshfield, Wisconsin, 2004

influenza season. MMWR 2008;57:393–8. 4. Edwards KM, Dupont WD, Westrich MK, Plummer WD Jr, Pame

PS, Wright PF. A randomized controlled trial of cold-adapred an inactivated vaccines for the prevention of influenza A disease. J Inici

Dis 1994;169:68–76. 5. Nichol KL, Nordin JD, Nelson DB, Mullooly JP, Hak E. Effectivene

of influenza vaccine in the community-dwelling elderly. N Engl | Mz

2007;357:1373-81. 6. Shuler CM, Iwamoto M, Bridges CB. Vaccine effectiveness agair

medically attended, laboratory-confirmed influenza among childre

aged 6 to 59 months, 2003–2004. Pediatrics 2007;119:e587-95. 7. Russell KL, Ryan MA, Hawksworth A, et al. Effectiveness of the

2003–2004 influenza vaccine among U.S. military basic trained i year of suboptimal match between vaccine and circulating strain. lä

cine 2005;23:1981-5. 8. Kaiser L, Wat C, Mills T, Mahoney P, Ward P, Hayden F. Impact ent

oseltamivir treatment on influenza-related lower respiratory tract conplications and hospitalizations. Arch Intern Med 2003;163:1667-

..). McGeer A, Green KA, Plevneshi A, et al. Antiviral therapy and out

comes of influenza requiring hospitalization in Ontario, Canada. Clin

Infect Dis 2007;45:1568–75. -). World Health Organization. Influenza A (H1N1) virus resistance to

oseltamivir-last quarter 2007 to 4 April 2008. Geneva, Switzerland: World Health Organization; 2008 Available at csr/disease/influenza/H1N1Resistance Web20080403.pdf.

CDC provides annually updated English- and Spanishlanguage planning guides, campaign materials, and public relations tools. These include timely key messages, radio public service announcements, and sample media kits. These resources and event listings are available at http:// Additional information about VWA is available at http://www.paho. org/english/dd/pin/vw2008.htm. References 1. CDC. Recommended immunization schedules for persons aged 0-18

years—United States, 2008. MMWR 2008;57:Q1-4. 2. Zhou F, Santoli J, Messonnier ML, et al. Economic evaluation of the 7

vaccine routine childhood immunization schedule in the United States, 2001. Arch Pediatr Adolesc Med 2005;159:1136–44.

Jotice to Readers

Notice to Readers

National Infant Immunization Week

April 19–26, 2008 The week of April 19–26, 2008, is National Infant nmunization Week (NIIW) and Vaccination Week in the mericas (VWA). Immunization is one of the most effecve ways to protect infants and children from potentially erious diseases. During the week, hundreds of communies throughout the United States are expected to sponsor ctivities to emphasize the health benefits of timely vacciation and the importance to parents, health-care providrs, and communities of maintaining high vaccination overage. One message stressed during this week will be ne key role of the ongoing relationship among parents and heir children's health-care providers in vaccination prorams. CDC encourages parents to talk to their healthare providers about vaccinations at any time.

The week's activities provide an opportunity to showcase : le success of vaccination in saving the lives and protecting ne health of children. The currently recommended childood vaccination schedule (1) includes vaccines that preent infectious diseases such as measles, polio, whooping pugh, some forms of meningitis and pneumonia, and liver ancer. An analysis of the impact of seven vaccines showed hat they would prevent approximately 33,500 deaths and 4 million illnesses per annual birth cohort (2). NIIW-VWA events held in collaboration with CDC and ate and local health departments will be hosted in Rhode land, Connecticut, and Washington. Events held in colboration with CDC, state and local health departments, ne United States-Mexico Border Health Commission, and ne Pan American Health Organization (PAHO), will be osted in communities along the U.S.-Mexico border, with ick-off events held in El Paso, Texas, and Sunland Park, lew Mexico. In all locations, events will include educaon activities for health-care providers, media briefings, id immunization clinics. VWA, sponsored by PAHO, targets children and other ulnerable and underserved populations who have low vacnation coverage rates, in all countries in the Western hemihere. To support NIIW and VWA events nationwide,

International Course in Applied

Epidemiology CDC and Emory University's Rollins School of Public Health will cosponsor the International Course in Applied Epidemiology, to be held September 22–October 17, 2008, in Atlanta, Georgia. The course is designed for public health professionals from countries other than the United States. It will include presentations and discussions of epidemiologic principles, basic statistical analysis, public health surveillance, field investigations, surveys and sampling, and the epidemiologic aspects of current major public health problems in global health.

Group discussions of epidemiologic case exercises based on field investigations will be held during the course. Participants are encouraged to give a short presentation reviewing some epidemiologic data from their own country. The course also will include computer training using Epi Info (Windows version), a software program for epidemiologists developed at CDC and the World Health Organization.

Prerequisites are familiarity with the vocabulary and principles of basic epidemiology, or completion of CDC's Principles of Epidemiology home-study course or equivalent. Preference will be given to applicants whose work involves priority public health problems in international health. Tuition is charged.

Additional information and applications are available by mail (Emory University, Rollins School of Public Health, Hubert Global Health Dept. (Attn: Pia], 1518 Clifton Rd. NE, Rm. 746, Atlanta, GA 30322); fax (404-727-4590), e-mail (, or Internet (http://www.

Notice to Readers

Web Series: HIV/AIDS Crisis Among

African Americans CDC and the Public Health Training Network will offer the six-part web series, A Call to Action for Leaders: The Crisis of HIV/AIDS Among African Americans, available online beginning June 30, 2008. This series is designed to 1) increase awareness of HIV/AIDS in African American communities; 2) highlight innovative, sustainable, and collaborative actions taken by leaders in places where African Americans live, work, play, learn, and worship; and 3)

provide links to available resources. David Satcher, form: Director of CDC and the 16th Surgeon General of the United States, will serve as senior host of the web series

. Each part of the series is a prerecorded, 30-minute seg ment, which can be viewed on computers with Interier access and Windows Media Player. The series will be avaiable at Parts 1–3 can be viewed beginning June 30, and parts 4-6 can be viewed begin ning November 30. A free DVD of this series can be ordered by telephone (800-458-5231) after June 30 (parts 1-3) and after November 30 (parts 1-6).

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Percentage of Asian Adults* Who Reported Moderate or Heavier Drinking, by Asian Subpopulation - National Health Interview Survey,

United States, 2004–2006%

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* Non-Hispanic Asians aged 18 years.
Respondents who had at least 12 drinks in their lifetime and more than three
drinks per week, up to 14 drinks per week (on average) for men, and more
than three drinks per week up to seven drinks per week (on average) for
women were moderate drinkers. Adults who had at least 12 drinks in their
lifetime and more than 14 drinks per week (on average) for men and more
than seven drinks per week (on average) for women were heavier drinkers.
$ Estimates are age adjusted using the projected 2000 U.S. population as the
standard population and using four age groups: 18–24 years, 25–44 years,
45–64 years, and >65 years. Estimates are based on household interviews
of a sample of the civilian, noninstitutionalized U.S. population and are derived
from the National Health Interview Survey sample adult component. Data
were combined from three years of surveys to increase reliability of estimates
in smaller subpopulations.
1 95% confidence interval.
** Includes Chinese, Filipino, Asian Indian, Japanese, Vietnamese, and Korean

subpopulations; also includes Other Asian and Native Hawaiian or Other
Pacific Islander subpopulations, which are not shown separately because

of small sample sizes.
# Among persons who reported a single Asian subpopulation.

During 2004–2006, Asian adults had the lowest percentage of current moderate or heavier drinkers (9%),
when compared with whites (22%), American Indian/Alaska Natives (15%), Hispanics (13%), and blacks
(12%). However, the percentage of moderate or heavier drinkers varied substantially among Asian
subpopulations: Japanese (14%), Korean (10%), Filipino (9%), Chinese (7%), Vietnamese (6%), and Asian
Indian (6%).
SOURCE: Barnes PM, Adams PF, Powell-Griner E. Health characteristics of the Asian adult population:
United States, 2004-2006. Adv Data 2008;394. Available at


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TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) - United States week ending April 12, 2008 (15th Week)*

5-year Current Cum weekly

Total cases reported for previous years Disease

week 2008 average 2007

2006 2005 2004 2003 States reporting cases during current week (hoi Anthrax


32 20 19

16 20 infant

97 85 87

76 other (wound & unspecified)


24 48 31

30 33 CA (1) Brucellosis

2 128 121 120 114 104

CA (2)


30 33

17 30 54 Cholera


2 Cyclosporiasis


91 137 543 160 75 Diphtheria

Domestic arboviral diseases $.1:
California serogroup


80 112 108 eastern equine



14 Powassan


1 St. Louis


13 12 41
western equine
Ehrlichia chaffeensis

739 578 506 338

321 Ehrlichia ewingii

1 Anaplasma phagocytophilum


3 732 646 786 537 362 undetermined

1 162 231 112


Haemophilus influenzae, **
invasive disease (age <5 yrs):
serotype b

22 29


19 32 nonserotype b

2 45
176 175 135 135 117

NY (2) unknown serotype

3 69

191 179 217 177 227 GA (1), AZ (1), AK (1) Hansen disease

1 19

73 66 87 105 95 MO (1) Hantavirus pulmonary syndromes

32 40


26 Hemolytic uremic syndrome, postdiarrheals


3 277 288 221 200 178 WA (1), CA (1) Hepatitis C viral, acute

16 883 766 652

1,102 PA (1), MI (1), MN (1), KY (1), OK (2) HIV infection, pediatric (age <13 yrs)


380 436 504 Influenza-associated pediatric mortalitys. At


76 43 45

FL (1)

11 785 884


753 696 NC (1), WA (1), CA (2), AK (1) Measles***



66 37 56 NY (1), AZ (2)
Meningococcal disease, invasivettt:
A, C, Y, & W-135


307 318 297 serogroup B


3 149 193 156 other serogroup



27 unknown serogroup

12 206
17 580 651 765

PA (1), OH (1), FL (1), WA (1), OR (1), CA (7) Mumps

2 172 113 778 6,584 314 258 231 NY (1), CO (1) Novel influenza A virus infections




1 Poliomyelitis, paralytic

1 Poliovirus infection, nonparalytics





12 Q fever: * total:

190 169 136


71 acute

9 chronic

4 Rabies, human


2 Rubella



7 Rubella, congenital syndrome

1 SARS-COV$****


8 - No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts.

* Incidence data for reporting years 2007 and 2008 are provisional, whereas data for 2003, 2004, 2005, and 2006 are finalized. * Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5

preceding years. Additional information is available at s Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 and 2008 for the domestic arboviral diseases

and influenza-associated pediatric mortality, and in 2003 for SARS-COV. Reporting exceptions are available at
9 Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vecto

Borne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II.
The names of the reporting categories changed in 2008 as a result of revisions to the case definitions. Cases reported prior to 2008 were reported in the categores
Ehrlichiosis, human monocytic (analogous to E. chaffeensis); Ehrlichiosis, human granulocytic (analogous to Anaplasma phagocytophilum), and Ehrlichiosis, unspecited J

other agent (which included cases unable to be clearly placed in other categories, as well as possible cases of E. ewingi).
# Data for H. influenzae (all ages, all serotypes) are available in Table II.
$$ Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Implementation of HIV reporting

influences the number of cases reported. Updates of pediatric HIV data have been temporarily suspended until upgrading of the national HIV/AIDS surveillance des

management system is completed. Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly. 17 Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases. Sixty-six cases occurring during the 2007-08 influerza

season have been reported.

Two measles cases reported for the current week were indigenous while one was imported. 71 Data for meningococcal disease (all serogroups) are available in Table II. $$$ in 2008, Q fever acute and chronic reporting categories were recognized as a result of revisions to the Q fever case definition. Prior to that time, case counts were noi

differentiated with respect to acute and chronic Q fever cases. 119 No rubella cases were reported for the current week.

Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases.

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