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Passive Smoking Continued

These data also show that the majority of Americans would choose nonsmoking sections in airplanes, restaurants, and other public places, if given a choice. In 1986, the Committee on Airliner Cabin Air Quality, which was appointed by the National Academy of Sciences, recommended a ban on smoking on all commercial domestic flights for the following reasons: 1) to lessen irritation and discomfort among passengers and crew, 2) to reduce potential health hazards for the cabin crew, 3) to eliminate the possibility of fires caused by cigarettes, and 4) to bring the cabin air quality into line with established standards for other closed environments (5). On April 23, 1988, a new federal law that prohibits smoking on domestic flights of 2 hours or less takes effect. This legislation is part of an ongoing national effort to protect nonsmokers from exposure to ETS. Regulations issued by the General Services Administration (GSA) in December 1986 now prohibit smoking in GSA-controlled facilities except in designated smoking areas (6). The 1990 Health Objectives for the Nation, which were adopted by the Public Health Service, recommend that all 50 states have laws by 1990 that both prohibit smoking in enclosed public places and require separate smoking areas in the workplace and in dining establishments (7). References 1. Office on Smoking and Health. The health consequences of involuntary smoking: a report of

the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, 1987:vii; DHHS publication no. (CDC):

87-8398. 2. Waksberg J. Sampling methods for random digit dialing. J Am Stat Assoc 1978;73:40-6. 3. Roper Organization. A study of public attitudes toward cigarette smoking and the tobacco

industry in 1978. New York: Roper Organization, May 1978. 4. Bureau of National Affairs. Where there's smoke: problems and policies concerning smoking

in the workplace. A BNA special report, 2nd ed. Rockville, Maryland: Bureau of National

Affairs, 1987. 5. National Academy of Sciences, Committee on Airliner Cabin Air Quality, Board on Environ

mental Studies and Toxicology, Commission on Life Sciences, National Research Council. The airliner cabin environment: air quality and safety. Washington, DC: National Academy

Press, 1986. 6. General Services Administration. Smoking regulations. Federal Register 1986;51:44258. (41

CFR Part 101-20). 7. Public Health Service. Promoting health/preventing disease: objectives for the nation.

Washington, DC: US Department of Health and Human Services, Public Health Service, 1980.

Update on Influenza Activity – United States and Worldwide,
with Recommendations for Influenza Vaccine Composition

for the 1988–89 Season Worldwide

Although influenza activity in the United States this season has been primarily associated with type A(H3N2), influenza B has been the predominant virus type reported from other areas of the world.

Between October 1987 and April 1988, localized outbreaks of influenza B occurred in Finland, France, Greece, the United Kingdom, West Germany, and the Union of Soviet Socialist Republics (U.S.S.R.). In Japan, a localized outbreak of influenza B occurred during November of 1987, and sporadically occurring cases were confirmed through February of 1988. Sporadically occurring cases of influenza B were also confirmed from North Korea during March. Influenza B has been the most frequently isolated influenza virus in the western provinces of Canada; during February, it was

Influenza Continued associated with an outbreak in Calgary, Alberta. Influenza B has also been the predominant virus type in Ontario since October of 1987. In the United States, influenza B has accounted for 9% of isolates reported nationally by World Health Organization (WHO) Collaborating Laboratories; only Hawaii has reported influenza B as the predominant virus type.

Influenza A(H3N2) caused localized outbreaks in Taiwan from September through November of 1987. Singapore reported isolating influenza A(H3N2) viruses from sporadically occurring cases during September and October 1987, and Japan made similar reports from October 1987 through February 1988. In Europe, influenza A(H3N2) was associated with localized outbreaks in East Germany and Romania during March. Localized outbreaks of influenza A(H3N2) in the U.S.S.R. during January and February escalated to widespread activity during March, as an epidemic of influenza B was waning. Sporadically occurring cases of influenza A(H3N2) were confirmed in several European countries, including Finland, France, Hungary, Norway, and the United Kingdom between January and March 1988 and in Egypt during January and February. Sporadic influenza A(H3N2) activity has also been reported in several Canadian provinces, and a few localized outbreaks have been associated with influenza A, but the subtype of these viruses has not been identified.

Sporadically occurring cases of influenza A(H1N1) have been confirmed in the United States since January of this year and have been confirmed recently in Canada. In Europe, influenza A(H1N1) was isolated from sporadically occurring cases in Switzerland during February and March. A localized outbreak of influenza A(H1N1) was reported in a primary school in Italy during March. United States

Surveillance indicators in the United States suggest that influenza activity is waning. Reports from state and territorial epidemiologists have shown a progressive decline in outbreak activity since the week ending March 12, when 57% of the states were still reporting regional or widespread outbreaks of influenza-like illness. For the week ending April 16, two states reported widespread activity, and five states reported regional activity. For the same week, the percentage of patients visiting reporting sentinel physicians for influenza-like illnesses dropped to a low of 3.4%, from a peak of 8.1% for the week ending February 20. The number of specimens tested and the number of influenza viruses isolated at WHO Collaborating Laboratories have also declined since the end of February, from a peak of over 1,700 specimens tested with approximately 300 influenza viruses isolated, to 448 specimens tested and 43 viruses isolated for the week ending April 16. However, the ratio of pneumonia and influenza deaths to deaths from all causes, which has declined since reaching a peak on the week ending March 5, remains above the epidemic threshold for the ninth week. Antigenic Analysis of Recent Influenza Isolates and Recommendations for Influenza Vaccine Composition for the 1988–89 Season

As previously reported (1), influenza A(H3N2) viruses isolated in the United States and in other parts of the world during the 1987–88 influenza season were found to be antigenically distinct from viruses that circulated from 1985 through the spring of 1987. Although influenza B viruses have been isolated less frequently, it has become clear, as more isolates become available, that antigenic variation has also occurred among these viruses. Analysis of recent influenza B virus isolates indicates that these antigenic variants are different from the previously prevalent strains B/USSR/100/83

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Influenza Continued and B/Ann Arbor/1/86 (Table 1). Most recent isolates resemble the reference strain BNictoria/2/87. The additional antigenic variant B/USSR/2/87, which was isolated in Moscow in December 1987, has been identified less frequently than strains that resemble BNictoria/2/87.

The antibody response induced by the current type B vaccine strain, B/Ann Arbor/1/86, is greater to the homologous virus than to the reference variant BNictoria/2/87 (Table 2). Vaccinees in all age groups developed neutralizing antibody titers >100 more frequently to B/Ann Arbor/1/86 than to the BNictoria/2/87 variant (2), and the geometric mean titers were higher to the homologous vaccine component than to the BNictoria/2/87 variant. During the 1987–88 season, influenza A(H1N1) viruses have continued to resemble the A/Taiwan/1/86 and A/Singapore/6/86 viruses, which were first isolated in Asia in 1986.

Based on antigenic analysis of recent influenza viruses, WHO has recommended updated type A(H3N2) and type B antigens for influenza vaccines for use during the 1988–89 influenza season. WHO recommends the same A(H1N1) component that was used in the 1987–88 vaccine (3). Consistent with these recommendations, the Public Health Service has recommended the following antigens for the trivalent influenza vaccine to be manufactured in the United States for the 1988–89 influenza season: A/Taiwan/1/86(H1N1), A/Sichuan/2/87(H3N2), and BNictoria/2/87. Reported by: F Ruben, MD, Univ of Pittsburgh, Pittsburgh, Pennsylvania. K Edwards, MD, P Palmer, Vanderbilt Univ, Nashville, Tennessee. RB Couch, MD, WA Keitel, MD, Baylor Coll of Medicine, Houston, Texas. National Influenza Centers, Microbiology and Immunology Support Svcs, WHO, Geneva. Div of Virology, Office of Biologics, FDA. Participating State and Territorial Epidemiologists and State Laboratory Directors. WHO Collaborating Center for Influenza, Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC. TABLE 1. Hemagglutination-inhibition reactions* of influenza type B viruses

Ferret Antisera B/USSR B/Yamanashi B/Ann Arbor B/Victoria B/USSR Reference Antigen 100/83




2187 B/USSR/100/83



40 B/Yamanashi/510/86



40 B/Ann Arbor/1/86



80 B/Victoria/2187



80 B/USSR/2/87



320 * Titers are the reciprocal of antiserum dilutions; homologous titers appear in bold type. Fourfold or greater differences in reactions of sera with different antigens are considered significant.



TABLE 2. Neutralizing antibody responses to influenza B viruses induced by the 1987-88 trivalent influenza vaccine*



Post-Vaccine % with Titer 2

% with Titer Population Strain

100 200 (GMT)* 100 200 (GMT)* Children/ B/Ann Arbor/1/86 42

23 (68) 87

84 (400) Young Adult BNictoria/2/87

6 (32) 42

58 (196) Elderly B/Ann Arbor/1/86 33

16 (35) 59


(73) B/Victoria/2/87

6 (22) 31


(40) *Volunteers received trivalent influenza vaccine containing 15ug each of A/Leningrad/360/83 (H3N2), A/Taiwan/1/86(H1N1), and B/Ann Arbor/1/86. *Geometric mean titer.

Influenza - Continued References 1. Centers for Disease Control. Influenza - United States. MMWR 1988;37:207-9. 2. Harmon MW, Rota PA, Walls HH, Kendal AP. Antibody response in humans to influenza virus

type B host-cell-derived variants after vaccination with standard (egg-derived) vaccine or

natural infection. J Clin Microbiol 1988;26:333-7. 3. World Health Organization. Recommended composition of influenza virus vaccines for use in

the 1988-89 season. Wkly Epidem Rec 1988;9:57-60.

FIGURE I. Reported measles cases - United States, Weeks 11-14, 1988

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*U.S. Government Printing Office: 1988-530-111/60073 Region IV

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April 29, 1988 / Vol. 37 / No. 16





245 Cholesterol Awareness in Selected

States – Behavioral Risk Factor

Surveillance, 1987 249 Trends in Years of Potential Life Lost

Due to Infant Mortality and Perinatal

Conditions, 1980–1983 and 1984–1985 257 Paralytic Poliomyelitis Senegal,

1986–1987: Update on the N-IPV T: Efficacy Study




MAYO 1998

Progress in Chronic Disease Prevention

Cholesterol Awareness in Selected States

Behavioral Risk Factor Surveillance, 1987

Over the past 10 years, the association between high levels of serum cholesterol and increased risk of coronary heart disease (CHD) has been well documented (1). In addition, a growing body of evidence demonstrates that individuals with elevated cholesterol levels can reduce their risk of CHD by lowering their serum cholesterol and that a 1% decline in serum cholesterol results in a 2% decline in the risk of cardiovascular disease (2). The 3%-4% decline in serum cholesterol reported among U.S. adults from 1960 to 1980 has probably contributed to the overall decline in CHD mortality observed during this period (3).

In November 1985, the National Heart, Lung, and Blood Institute (NHLBI) initiated the National Cholesterol Education Program (NCEP), a cooperative undertaking by health organizations in the United States (4). The goal of the program is to contribute to lowering the morbidity and mortality from CHD by reducing the prevalence of elevated serum cholesterol in this country.* The NCEP focuses on public education; its central theme is "Know your blood cholesterol number." Individuals are encouraged to ask about serum cholesterol the next time they see their doctor; to have their cholesterol tested if they have not already done so; to know their number, or level; and to learn whether their cholesterol level needs to be lower.

To determine the proportion of adults who report having taken these steps, data from the 33 states (including the District of Columbia) that participated in the 1987 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Since 1984, state health departments have collected these data by conducting telephone surveys of the adult residents of their states (5). Telephone surveys using random-digit dialing are conducted every month throughout the year, and approximately 1,500 interviews are completed annually in each state. Respondents are selected randomly from all adults living in each household. The results presented here are weighted to account for the age, race, and sex distribution of adults in each state in 1980 as well as for the respondents' probability of selection.

*A serum cholesterol level of 240 mg/dL or greater is considered "high"; 200 to 239 mg/dL is considered "borderline-high"; and less than 200 mg/dL is considered "desirable" (4).


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